Frequency, Immunogenetics, and Clinical Characteristics of Latent Autoimmune Diabetes in China (LADA China Study): A Nationwide, Multicenter, Clinic-Based Cross-Sectional Study

• Published in: Diabetes (New York, N.Y.) Vol. 62; no. 2; pp. 543 - 550
• Main Authors: ZHIGUANG ZHOU, YUFEI XIANG, LESLIE, R. David, LINONG JI, WEIPING JIA, GUANG NING, GAN HUANG, LIN YANG, JIAN LIN, ZHENQI LIU, HAGOPIAN, William A
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-02-2013
• Subjects: Adult; Adults; Autoantibodies - blood; Autoantibodies - genetics; Autoantibodies - immunology; Autoimmune diseases; Biological and medical sciences; Blood pressure; C-Peptide - blood; China - epidemiology; Cholesterol; Cross-Sectional Studies; Development and progression; Diabetes; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 1 - genetics; Diabetes Mellitus, Type 1 - immunology; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - genetics; Diabetes Mellitus, Type 2 - immunology; Diabetes. Impaired glucose tolerance; Diabetic ketoacidosis; Disease; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Fasting; Female; Genetic aspects; Genetic Predisposition to Disease; Glucose; Glutamate Decarboxylase - genetics; Glutamate Decarboxylase - immunology; Haplotypes; Health aspects; High density lipoprotein; HLA-DQ Antigens - genetics; HLA-DQ Antigens - immunology; Humans; Immunogenetics; Immunology and Transplantation; Insulin; Insulin resistance; Lipoproteins, HDL - blood; Male; Medical sciences; Metabolic syndrome; Metabolic Syndrome - epidemiology; Metabolic Syndrome - immunology; Middle Aged; Minority & ethnic groups; Peptides; Physiological aspects; Prediabetic State - epidemiology; Prediabetic State - genetics; Prediabetic State - immunology; Prevalence studies (Epidemiology); Risk; Type 2 diabetes; White people; Asia; China; Endocrinopathy; Autoimmunity; Immunogenetics; Diabetes mellitus; Cross sectional study
• ISSN: 0012-1797; 1939-327X
• DOI: 10.2337/db12-0207

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.