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Preserved beta-cell function present in adult-onset autoimmune diabetes
Patients with recently diagnosed adult-onset autoimmune diabetes demonstrated chronic hyperglycemia and partly preserved beta-cell function, both of which may contribute to impaired whole-body insulin sensitivity, according to researchers in Germany.
“Regarding beta-cell function in patients with [latent autoimmune diabetes of adults], some, but not all studies show an accelerated decline in insulin secretion when compared to type 2 diabetes,” Oana P. Zaharia, of the German Diabetes Center, Dusseldorf, and colleagues wrote. “However, only few data exist on beta-cell function and insulin sensitivity in patients with adult-onset autoimmune diabetes compared to type 2 diabetes and controls.”
The researchers compared matched, recently diagnosed groups of patients who were positive for antibodies against glutamic acid decarboxylase and/or adult-onset autoimmune diabetes, those with type 1 diabetes, type 2 diabetes and healthy controls (age, 41 to 62 years; n = 41 per group). Zaharia and colleagues assessed patients’ beta-cell function using glucagon tests and IV glucose tolerance tests and evaluated insulin sensitivity using hyperinsulinemic-euglycemic clamps.
Most patients with adult-onset autoimmune diabetes (n = 33; 81%) were initially diagnosed with type 2 diabetes, Zaharia and colleagues wrote. BMI was higher among patients with autoimmune diabetes compared with those with type 1 diabetes (27.8 kg/m2 vs. 25 kg/m2; P < .05), but lower than those with type 2 diabetes (BMI, 31.9 kg/m2; P < .05), and similar to that of the control group (29.4 kg/m2), the researchers reported.
Glutamic acid decarboxylase antibody titers were negatively correlated with BMI in patients with autoimmune diabetes (P < .05), the researchers wrote, as well as with C-peptide secretion (P < .05).
Patients with autoimmune diabetes had 228% higher beta-cell function than those with type 1 diabetes in an IV glucose tolerance test, the researchers reported. However, beta-cell function was 35% lower than in patients with type 2 diabetes, and 61% lower than controls (P < .05 for all).
Patients with autoimmune diabetes had insulin sensitivity rates similar to those of controls and patients with type 1 diabetes, but significantly higher than that of patients with type 2 diabetes (41%; P < .05) after adjustment for BMI and HbA1c or fasting glucose.
“In conclusion, adult patients with recently diagnosed autoimmune diabetes have higher insulin sensitivity than patients with type 2 diabetes, but specifically patients with autoimmune diabetes without initial insulin treatment have a partly preserved beta-cell function at the onset of diabetes,” Zaharia and colleagues wrote. “When compared to healthy humans, [patients with autoimmune diabetes] show impaired whole-body insulin sensitivity possibly due to chronic hyperglycemia.” – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.