Comment on Liu et al. Latent Autoimmune Diabetes in Adults With Low-Titer GAD Antibodies: Similar Disease Progression With Type 2 Diabetes: A Nationwide, Multicenter Prospective Study (LADA China Study 3). Diabetes Care 2015;38:16–21

Shah, Viral N.; Yu, Liping

doi:10.2337/dc14-2575

Diabetes Care

2015

DOI: 10.2337/dc14-2575

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Comment on Liu et al. Latent Autoimmune Diabetes in Adults With Low-Titer GAD Antibodies: Similar Disease Progression With Type 2 Diabetes: A Nationwide, Multicenter Prospective Study (LADA China Study 3). Diabetes Care 2015;38:16–21

Viral N. Shah

Liping Yu

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Cited by 3 publications

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Toward an Improved Classification of Type 2 Diabetes: Lessons From Research into the Heterogeneity of a Complex Disease

Redondo

Balasubramanyam

2021

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Accumulating evidence indicates “type 2 diabetes (T2D)” is phenotypically heterogeneous. Defining and classifying variant forms of T2D are priorities to better understand its pathophysiology and usher clinical practice into an era of “precision diabetes”. Evidence Acquisition and Methods We reviewed literature related to heterogeneity of T2D over the past five decades and identified a range of phenotypic variants of T2D. Their descriptions expose inadequacies in current classification systems. We attempt to link phenotypically diverse forms to pathophysiology, explore investigative methods that have characterized “atypical” forms of T2D on an etiological basis, and review conceptual frameworks for an improved taxonomy. Finally, we propose future directions to achieve the goal of an etiological classification of T2D. Evidence Synthesis Differences among ethnic and racial groups were early observations of phenotypic heterogeneity. Investigations that uncover complex interactions of pathophysiologic pathways leading to T2D are supported by epidemiological and clinical differences between the sexes and between adult and youth-onset T2D. Approaches to an etiological classification are illustrated by investigations of atypical forms of T2D, such as monogenic diabetes and syndromes of Ketosis-Prone Diabetes. Conceptual frameworks that accommodate heterogeneity in T2D include an overlap between known diabetes types, a “palette” model integrated with a “threshold hypothesis”, and a spectrum model of atypical diabetes. Conclusion The heterogeneity of T2D demands an improved, etiological classification scheme. Excellent phenotypic descriptions of emerging syndromes in different populations, continued clinical and molecular investigations of atypical forms of diabetes, and useful conceptual models can be utilized to achieve this important goal.

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Toward an Improved Classification of Type 2 Diabetes: Lessons From Research into the Heterogeneity of a Complex Disease

Redondo

Balasubramanyam

2021

The Journal of Clinical Endocrinology &Amp; Metabolism

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Combined Detection of Islet Autoantibodies for Clinical Diagnosis of Type 1 Diabetes in the Low-Prevalence Population

Chen

et al. 2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Single positive islet autoantibodies (IAbs), sometimes detected in healthy individuals and low risk type 1 diabetes (T1D) patients, are considered to be irrelevant to the development of diabetes, making it difficult to diagnose and classify adult-onset diabetics. Objective To determine the significance and clinical value of IAbs in T1D diagnosis in the low-prevalence population; and to explore whether electrochemiluminescence (ECL)-IAb detection assay can improve the clinical utility of IAbs in the immunodiagnosis of T1D in the low-prevalence population. Participants and methods A total of 633 newly-diagnosed adult-onset diabetic patients (≥18 years old) were divided into two groups according to their clinical phenotypes: 575 patients with age at diagnosis ≥35 years and body mass index (BMI) ≥ 24 kg/m2 were considered a low-prevalence population (population with a low prevalence of T1D) and the other 58 patients were considered a high-prevalence population. All the samples from 633 participants were tested with IAbs using standard radiobinding assays (RBA) and electrochemiluminescence (ECL) assay, in parallel. Results Compared with the high-prevalence population, fewer positive IAbs (94/575, 16.3% vs. 28/58, 48.3%) were detected in the low-prevalence population, and more of which (69/94, 73.4% vs. 9/28, 32.2%) were positive for a single IAb, with GADA being the most prevalent single-IAb. Single-IAb detection in the low-prevalence population did not always suggest T1D phenotype. Combined detection of IAbs by RBA and ECL assays had a significant clinical utility to distinguish autoimmune diabetes in the low-prevalence population with low BMI, poor β-cell function at the diagnosis, and an accelerated decline in β-cell function during the follow-up. Conclusions Combined autoantibody detection by RBA and ECL assays improved differentiating autoimmune from non-autoimmune diabetes in the low-prevalence population.

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Response to Comment on Liu et al. Latent Autoimmune Diabetes in Adults With Low-Titer GAD Antibodies: Similar Disease Progression With Type 2 Diabetes: A Nationwide, Multicenter Prospective Study (LADA China Study 3). Diabetes Care 2015;38:16–21

Liu

Xiang

et al. 2015

Diabetes Care

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Comment on Liu et al. Latent Autoimmune Diabetes in Adults With Low-Titer GAD Antibodies: Similar Disease Progression With Type 2 Diabetes: A Nationwide, Multicenter Prospective Study (LADA China Study 3). Diabetes Care 2015;38:16–21

Cited by 3 publications

References 6 publications

Toward an Improved Classification of Type 2 Diabetes: Lessons From Research into the Heterogeneity of a Complex Disease

Toward an Improved Classification of Type 2 Diabetes: Lessons From Research into the Heterogeneity of a Complex Disease

Combined Detection of Islet Autoantibodies for Clinical Diagnosis of Type 1 Diabetes in the Low-Prevalence Population

Response to Comment on Liu et al. Latent Autoimmune Diabetes in Adults With Low-Titer GAD Antibodies: Similar Disease Progression With Type 2 Diabetes: A Nationwide, Multicenter Prospective Study (LADA China Study 3). Diabetes Care 2015;38:16–21

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