Lada, Prevalence and Phenotype in South Indian Population

Presentation Number: MON 579
Date of Presentation: April 3rd, 2017

Arun Mukka1, Alok Sachan*2, Suresh Vaikakkara3 and Aparna R Bitla3
1Yashoda Hospital, Hyderabad, India, 2Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India, 3Sri Venkateswara Institute of Medical Sciences, Tirupati, India

Abstract

Introduction: Some studies in select population from India have reported a variable prevalence of Latent Autoimmune Diabetes in Adults (LADA). Hence it was planned to evaluate the prevalence of LADA in an unselected group of patients with type 2 diabetes mellitus (T2DM).

Underlying questions: To study the prevalence of LADA and to characterize the phenotype.

Methodology: A cross sectional study was conducted by recruiting cases from the patients attending the out patient clinics. Cases were selected from among patients with T2DM who had age of onset > 35 yrs and duration < 3 years. Calculated sample size, based on the assumption of 5% prevalence was 73. Controls, who were non diabetic on OGTT and did not have any autoimmune disease either, were also recruited. To define LADA, autoantibodies against glutamic acid decarboxylase (GAD) and insulinoma-associated protein 2 (IA2) were measured with ELISA kits (Aeskulisa, Germany). Cutoffs for the autoantibodies were derived from the 99th percentile of the control sera.

Results: Age of cases (N=126, men 61, women 65) was 52.5 ± 9.8 years and duration of diabetes was 18 ± 8.5 months. GAD antibody was seen in 5 (3.9%) cases while IA2 was seen in 4 (3.1%) cases. None of the cases had both the antibodies. Similar prevalence for either of the antibodies was seen among the cases (N=9, 7.1%) and the controls (N=4, 3.5% p=0.69).

More patients with LADA were using insulin (2/9, 22%) than patients with T2DM(3/117, 2.6%). Patients with LADA were comparable in terms of age, duration of diabetes, family history of diabetes, body mass index and HbA1c to patients with T2DM. Similarly, prevalence of hypothyroidism and metabolic syndrome was also similar among the 2 groups. All the GAD positive cases were older than 60 years of age.

Conclusions: LADA is uncommon in South India. Higher requirement of insulin therapy and older age are the only features different from patients with T2DM.

 

Nothing to Disclose: AM, AS, SV, ARB