Lower mortality and cardiovascular event rates in patients with Latent Autoimmune Diabetes In Adults (LADA) as compared with type 2 diabetes and insulin deficient diabetes: A cohort study of 4368 patients

Wod, Mette; Thomsen, Reimar Wernich; Pedersen, Lars; Yderstræde, Knud Bonnet; Beck‐Nielsen, Henning; Højlund, Kurt

doi:10.1016/j.diabres.2018.02.042

Cited by 17 publications

(15 citation statements)

References 26 publications

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“…An analysis conducted with 45 LADA patients from a cohort of the Fremantle Diabetes Study found similar crude incidence rates of myocardial infarction, stroke or cardiac mortality to those in T2D patients, again despite the significant differences in CV risk factors . On the contrary, in a recent cohort study LADA seemed to be associated with lower short‐term risk of CV events and mortality, even though patients with insulin‐dependent diabetes were not considered as possibly affected by LADA. Another cross‐sectional study showed that LADA patients had a higher prevalence of carotid atherosclerosis than age‐matched T2D patients .…”

Section: Discussionmentioning

confidence: 75%

Long‐term risk of cardiovascular disease in individuals with latent autoimmune diabetes in adults (UKPDS 85)

Maddaloni

Coleman

Pozzilli

et al. 2019

Diabetes Obesity Metabolism

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Aims: Latent autoimmune diabetes in adults (LADA) is diagnosed in up to 12% of adults with clinically diagnosed type 2 diabetes (T2D). LADA tends to have healthier cardiovascular (CV) risk profiles than T2D, but it remains uncertain whether the risk of CV events differs between the two. We examined the risk of CV events in patients enrolled in the United Kingdom Prospective Diabetes Study (UKPDS) according to LADA status. Materials and methods: Diabetes autoantibodies (AAb) were measured in 5062 UKPDS participants. The incidence of major adverse CV events (MACE), defined as CV death, non-fatal myocardial infarction or non-fatal stroke, was compared in those with LADA (≥1 AAb test positive) and those without LADA (AAb negative). Results: There were 567 participants (11.2%) with LADA. Compared with participants with T2D, they were younger, with higher mean HbA1c and HDL-cholesterol values, and with lower body mass index and total cholesterol and systolic blood pressure values (all P < 0.01). After a median (25th, 75th percentile) 17.3 (12.6-20.7) years of follow-up, MACE occurred in 157 (17.4 per 1000 person-years) participants with LADA and in 1544 (23.5 per 1000 person-years) participants with T2D (HR, 0.73; 95% confidence interval [CI], 0.62-0.86; P < 0.001). However, after adjustment for confounders, this difference was no longer significant (HR adj , 0.90; 95% CI, 0.76-1.07; P = 0.22).Conclusions: In adults thought to have newly diagnosed T2D, the long-term risk of MACE was lower in those with LADA. However, this did not differ after adjustment for traditional CV risk factors, suggesting that measurement of AAb in addition to traditional CV risk factors will not aid in stratification of CV risk in clinically diagnosed T2D.

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Section: Discussionmentioning

confidence: 75%

Long‐term risk of cardiovascular disease in individuals with latent autoimmune diabetes in adults (UKPDS 85)

Maddaloni

Coleman

Pozzilli

et al. 2019

Diabetes Obesity Metabolism

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“…However, a post-hoc analysis from UKPDS study showed a lower risk of microvascular complications at diabetes onset in LADA patients comparing to T2DM, followed by a higher risk after 9 years of disease due to worse glycaemic control [23]. In what concerns to cardiovascular disease, it seems to occur at a higher frequency in T2DM, comparing to LADA and T1DM [22,24]. Our study showed a non-statistically signi cant trend to a higher proportion of T1DM patients with macrovascular complications.…”

Section: Metabolic Control and Diabetes Complicationsmentioning

confidence: 99%

Adult-onset autoimmune diabetes: comparative analysis of classical and latent presentation

Fadiga

Saraiva

Catarino

et al. 2020

Preprint

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Introduction: Adult-onset autoimmune diabetes (AID) has two different phenotypes: classic type 1 diabetes mellitus (T1DM), with insulin requirement just after diagnosis, and latent autoimmune diabetes in adults (LADA). The purpose of this study is to characterize patients with AID followed on a tertiary centre, comparing classic T1DM and LADA.Methods: We collected data from patients with diabetes and positive islet autoantibodies, aged 30 years old and over at diagnosis. Patients who started insulin in the first 6 months were classified as T1DM and patients with no insulin requirements in the first 6 months were classified as LADA. Data regarding clinical presentation, autoantibodies, A1C and C-peptide at diagnosis, pharmacologic treatment and complications were analysed. Results: We included 92 patients, 46 with classic T1DM and 46 with LADA. The percentage of females was 50% in T1DM group and 52.1% in LADA group. The median age at diagnosis was 38 years (IQR – 15) for T1DM and 42 years (IQR – 15) for LADA (p=0.057). The median time between diagnosis of diabetes and diagnosis of autoimmune aetiology was 0 months in T1DM group and 60 months in LADA group (p<0.001). The mean BMI at diagnosis was 24.1Kg/m2 in T1DM group and 26.1Kg/m2 in LADA group (p=0.042). In T1DM group, 67.4% of the patients had more than one positive autoantibody, comparing to 41.3% of LADA patients (p=0.012). There was no statistical difference in what concerns to title of GAD autoantibodies, A1C and C-peptide at diagnosis of autoimmune aetiology. The presence of symptoms at diagnosis was associated with T1DM group (p<0.001). The median daily insulin dose was 40IU for T1DM (0.58IU/Kg) and 33.5IU for LADA (0.57IU/Kg), with no statistical difference. LADA patients were more often under non-insulin antidiabetic drugs (p=0.001). At 10 years follow up, 21.1% of T1DM patients and 63.3% of LADA patients had microvascular complications (p=0.004). Diabetic nephropathy was present in 23.5% of T1DM patients and 53.3% of LADA patients (p=0.047). At the last evaluation, 55.6% of T1DM and 82.6% of LADA patients had metabolic syndrome and this difference was independent of diabetes duration. Conclusion: Patients with classic T1DM presented more often with symptoms, lower BMI and higher number of autoantibodies, which may be related to a more aggressive autoimmune process. Patients with LADA developed more frequently microvascular complications for the same disease duration, namely diabetic nephropathy, and had more often metabolic syndrome.

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“…The FDDB cohort has proven useful in previous publications, and several studies are ongoing 13 19 20. In a cross-sectional study of 4374 adults, measurement of fasting C-peptide and the presence or absence of GAD autoantibodies at first hospital admission with diabetes could be used to define a subgroup of patients with clinically relevant differences in glycaemic control and markers of cardiovascular disease risk (BMI, blood pressure, lipid profile and liver enzymes) 20.…”

Section: Findings To Datementioning

confidence: 99%

“…Based on the literature, the prevalence of diabetic retinopathy was fairly comparable to diabetic patients from cohorts in similar countries, including Sweden21 and Wales,22 supporting that the FDDB comprises a relatively representative sample of patients with diabetes. The FDDB has also been used to study the prognosis related to diabetes 19. Patients with latent autoimmune diabetes in adults (LADA), representing ~10% of patients with type 2 diabetes with circulating islet autoantibodies as seen in type 1 diabetes mellitus, were identified and followed for subsequent mortality and cardiovascular outcomes.…”

Section: Findings To Datementioning

confidence: 99%

Cohort profile: the Funen Diabetes Database—a population-based cohort of patients with diabetes in Denmark

et al. 2020

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PurposeDetailed population-based data are essential to understanding the epidemiology of diabetes and its clinical course. This article describes the Funen Diabetes Database (FDDB). The purpose of the FDDB was to serve as a shared electronic medical record system for healthcare professionals treating patients with diabetes. The cohort can also be used for research.ParticipantsThe FDDB covers a geographical area of almost 500 000 Danish inhabitants. It currently includes 3691 patients with type 1 diabetes, 19 085 patients with type 2 diabetes, 292 patients with other types of diabetes and 5992 patients with an unknown type of diabetes. Patients have been continuously enrolled from general practitioners and endocrinology departments in the Funen area in Denmark since 2003. Patients undergo a clinical work-up at their first diabetes contact and during follow-up visits. The information collected includes type of diabetes contact, blood pressure, height, weight, lifestyle factors (smoking, exercise), laboratory records (eg, haemoglobin A1c and cholesterol levels), results from foot examinations (eg, pulse, cutaneous sensitivity and ankle brachial index), results from eye examinations (eg, degree of retinopathy assessed by retinal photo and eye examination), glucose-lowering drugs and diabetic complications.Findings to dateThe FDDB cohort was followed for a total of 212 234 person-years up to 2016. A cross-sectional study described the prevalence of diabetic retinopathy and its associated risk factors. The clinical outcomes of patients with type 1 diabetes, type 2 diabetes and latent autoimmune diabetes in adults have been assessed. Linkage to population-based medical registries with complete follow-up has enabled the collection of extensive continuous data on general practice contacts, diagnoses and procedures from hospital contacts, medication use and mortality.Future plansThe FDDB serves as a strong data resource that will be used in future studies of diabetes epidemiology with focus on occurrence, risk factors, treatment, complications and prognosis.

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Lower mortality and cardiovascular event rates in patients with Latent Autoimmune Diabetes In Adults (LADA) as compared with type 2 diabetes and insulin deficient diabetes: A cohort study of 4368 patients

Abstract: LADA seems to be associated with lower mortality and lower risk of cardiovascular events, compared with both T2D and IDD.

Cited by 17 publications

References 26 publications

Long‐term risk of cardiovascular disease in individuals with latent autoimmune diabetes in adults (UKPDS 85)

Long‐term risk of cardiovascular disease in individuals with latent autoimmune diabetes in adults (UKPDS 85)

Adult-onset autoimmune diabetes: comparative analysis of classical and latent presentation

Cohort profile: the Funen Diabetes Database—a population-based cohort of patients with diabetes in Denmark

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