Autoantibodies to glutamic acid decarboxylase and phenotypic features associated with early insulin treatment in individuals with adult-onset diabetes mellitus

Abstract

We investigated the association of serum antibodies to glutamic acid decarboxylase (GADab) with early start of insulin treatment (≤ 1 year from diagnosis, or ≤ 2 years from diagnosis) using data from a representative sample of 374 adult‐onset insulin‐treated individuals from the Tasmanian Diabetes Register. Furthermore, we examined whether this association was stronger than the phenotypic characteristics (age at diagnosis, sex, family history of diabetes, level of obesity, duration of diabetes) often used for diabetes classification. In this cohort, 35.9 % of males and 38.5 % of females were GADab positive. Within the first year from diagnosis, 78.4 % of GADab positive people compared to 44.0 % of GADab negative people (p < 0.001) had started insulin treatment. Univariate associations with insulin treatment ≤ 1 year from diagnosis included GADab positivity, no family history of diabetes, lower BMI for men, and GADab positivity and lower BMI for women. In multivariate models, significant associations with insulin treatment ≤ 1 year from diagnosis included a family history of diabetes (OR = 0.47, 95 % CI = 0.23–0.95) and GADab positivity (OR = 2.19, 95 % CI = 1.01–4.73) for men, but only GADab positivity (OR = 7.53, 95 % CI = 3.09–18.30) for women. Age at diagnosis was not associated with insulin treatment ≤ 1 year or ≤ 2 years from diagnosis for either sex. These findings indicate that a positive GADab test result is strongly associated with start of insulin treatment within 1 or 2 years from diagnosis, more so than characteristics such as level of obesity and age at diagnosis. © 1998 John Wiley & Sons, Ltd.

Clinical and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes

“…Four parallel RCTs 92-95 compared the effects of CSII with MDI in pregnancy (Tables 4 and 11-14, Appendices 7 and 11), although the sample size in three of the studies was small (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) …”

“…15,16 The approximate prevalences of insulin-treated diabetes in different age groups are shown in Table 1.…”

Diabetes epidemiology as a tool to trigger diabetes research and care

“…We investigated the association of anti-GAD positivity with early commencement of insulin treatment in adult-onset diabetes to ascertain whether this association is stronger than other phenotypic characteristics often used for classification of diabetes [57]. In this cohort, 36 % of males and 39 % of females were found to be positive for anti-GAD.…”

“…In this cohort, 36 % of males and 39 % of females were found to be positive for anti-GAD. For males, factors associated with early insulin treatment included anti-GAD positivity, a family history of diabetes and a lower BMI at diagnosis [57]. For females, the factors associated with early insulin treatment included anti-GAD positivity and absence of obesity.…”

Islet Cell Autoimmunity in a Triethnic Adult Population of the Third National Health and Nutrition Examination Survey

“…It is projected that the prevalence of diabetes will continue to grow and that the largest increase will be among those aged Ն75 years (2,3). It has increasingly become more evident that in adults and the elderly, clinical criteria alone are no longer sufficient to permit an accurate distinction of type of diabetes (4,5). Markers of humoral islet cell autoimmunity seem to hold great promise as determinants of risk for autoimmune diabetes and for enhancing diabetes classification, even in older populations (6).…”