Frequency, Immunogenetics, and Clinical Characteristics of Latent Autoimmune Diabetes in China (LADA China Study)

A Nationwide, Multicenter, Clinic-Based Cross-Sectional Study

  1. on behalf of the LADA China Study Group*
  1. 1Diabetes Center, Institute of Metabolism and Endocrinology, The Second Xiangya Hospital and Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Changsha, China
  2. 2Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
  3. 3Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
  4. 4Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Ruijin Hospital, Shanghai, China
  5. 5Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Virginia Health System, Charlottesville, Virginia
  6. 6Pacific Northwest Diabetes Research Institute, Seattle, Washington
  7. 7Department of Diabetes and Metabolic Medicine, Blizard Institute, London, U.K.
  1. Corresponding author: Zhiguang Zhou, zhouzg{at}hotmail.com.

Abstract

Adult non–insulin requiring diabetes includes latent autoimmune diabetes of adults (LADA), distinguished from type 2 diabetes by the presence of islet autoantibodies. LADA China determined the characteristics of Chinese LADA. This nationwide, multicenter, clinic-based cross-sectional study was conducted in 46 university-affiliated hospitals in 25 Chinese cities. All 4,880 ketosis-free diabetic patients (<1 year postdiagnosis, without insulin therapy for >6 months, aged ≥30 years) had GAD antibody (GADA) and HLA-DQ genotype measured centrally with clinical data collected locally. GADA-positive subjects were classified as LADA. Of the patients, 5.9% were GADA positive with LADA. LADA showed a north-south gradient. Compared with GADA-negative type 2 diabetes, LADA patients were leaner, with lower fasting C-peptide and less metabolic syndrome. Patients with high GADA titers are phenotypically different from those with low GADA titers, while only a higher HDL distinguished the latter from those with type 2 diabetes. HLA diabetes–susceptible haplotypes were more frequent in LADA, even in those with low-titer GADA. HLA diabetes-protective haplotypes were less frequent in LADA. Our study implicates universal immunogenetic effects, with some ethnic differences, in adult-onset autoimmune diabetes. Autoantibody positivity and titer could be important for LADA risk stratification and accurate therapeutic choice in clinical practice.

  • Received February 20, 2012.
  • Accepted July 25, 2012.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

| Table of Contents

This Article

  1. Diabetes vol. 62 no. 2 543-550
  1. All Versions of this Article:
    1. db12-0207v1
    2. 62/2/543 most recent