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Mollo A.,Institute Catala Of La Salut | Hernandez M.,Hospital Universitari Arnau Of Vilanova | Hernandez M.,University of Lleida | Marsal J.R.,Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol | And 15 more authors.
Diabetes/Metabolism Research and Reviews | Year: 2013

Background: The aim of this study was to characterize the clinical characteristics and insulin secretion in adults with latent autoimmune diabetes in adults (LADA). We also compared these characteristics in subjects with antibody-negative type 2 diabetes (T2DM) or adult-onset type 1 diabetes (T1DM) to subjects with LADA. Methods: In this cross-sectional study, 82 patients with LADA, 78 with T1DM and 485 with T2DM were studied. Clinical and metabolic data, in particular those that related to metabolic syndrome, fasting C-peptide and islet-cell autoantibodies [glutamic acid decarboxylase (GADAb) and IA2 (IA2Ab)] were measured. Results: The frequency of metabolic syndrome in patients with LADA (37.3%) was higher than in those with T1DM (15.5%; p=0.005) and lower than in patients with T2DM (67.2%; p<0.001). During the first 36months of the disease, the C-peptide concentration in LADA patients was higher than in subjects with T1DM but was lower than in T2DM patients (p<0.01 for comparisons). Glycemic control in LADA patients (HbA1c 8.1%) was worse than in patients with T2DM (HbA1c 7.6%; p =0.007). An inverse association between GADAb titers and C-peptide concentrations was found in subjects with LADA (p<0.001). Finally, LADA patients rapidly progressed to insulin treatment. Conclusions: As in other European populations, patients with LADA in Spain have a distinct metabolic profile compared with patients with T1DM or T2DM. LADA is also associated with higher impairment of beta-cell function and has worse glycemic control than in T2DM. Beta cell function is related to GADAb titers in patients with LADA. © 2013 John Wiley & Sons, Ltd.

Hernandez M.,Hospital Universitari Arnau Of Vilanova | Hernandez M.,University of Lleida | Mollo A.,Institute Catala Of La Salut | Marsal J.R.,Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol | And 11 more authors.
BMC Endocrine Disorders | Year: 2015

Background: The study of endogenous insulin secretion may provide relevant insight into the comparison of the natural history of adult onset latent autoimmune diabetes (LADA) with types 1 and 2 diabetes mellitus. The aim of this study was to compare the results of the C-peptide response to mixed-meal stimulation in LADA patients with different disease durations and subjects with type 2 and adult-onset type 1 diabetes. Methods: Stimulated C-peptide secretion was assessed using the mixed-meal tolerance test in patients with LADA (n=32), type 1 diabetes mellitus (n=33) and type 2 diabetes mellitus (n = 30). All patients were 30 to 70 years old at disease onset. The duration of diabetes in all groups ranged from 6 months to 10 years. The recruitment strategy was predefined to include at least 10 subjects in the following 3 disease onset categories for each group: 6 to 18 months, 19 months to 5 years and 5 to 10 years. Results: At all time-points of the mixed-meal tolerance test, patients with LADA had a lower stimulated C-peptide response than the type 2 diabetes group and a higher response than the type 1 diabetes group. The same results were found when the peak or area under the C-peptide curve was measured. When the results were stratified by time since disease onset, a similar pattern of residual insulin secretory capacity was observed. Conclusions: The present study shows that the magnitude of stimulated insulin secretion in LADA is intermediate between that of type 1 and type 2 diabetes mellitus. © 2015 Hernandez et al.; licensee BioMed Central.

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