Abstract
Background: Immune mediated destruction of pancreatic beta cell in type-I diabetes is well established but its’ role in young type-2 diabetic patients is still not conclusive. These young diabetic patients pass through several stages where they do not need insulin but found to have serum autoantibody against islets cell and even become dependent on insulin for survival in course of time. This study aims to find the presence of islets cell auto-antibodies (ICA) and autoantibody to glutamic acid decarboxylase-65 (GAD-65) in non-insulin requiring young diabetic patients of Bangladesh.
 Objective: To evaluate the presence of ICA and GAD-65 between the non-insulin requiring young type-2 diabetic patients and compare with the non-diabetic control group.
 Method: This case control study was carried out at the Department of Immunology, BIRDEM General Hospital, Dhaka for a period of one year from July 2013, A total of 120 non-insulin requiring (≥12 months) young type-2 diabetic patients and 60 age, sex matched non-diabetic were enrolled as control subjects following inclusion and exclusion criteria. ICA and GAD-65 tests were performed by enzyme linked immune-sorbent assay (ELISA) method by using kits from DRG Inc. International, USA.
 Results: In this study statistically significant difference found between non insulin requiring young diabetic patients and non diabetic control in respect of positive ICA result (p=0.015). The moderately strong negative association was found between different age of onset of diabetes mellitus and value of ICA level (r=-0.45). Only 20-24 years age group showed statistically significant difference between patient and control (p=0.013). Statistically significant difference was not found in GAD-65 values of non insulin requiring young diabetic patients and non diabetic controls (p=0.441).
 Conclusion: This study revealed that there is significant difference present in respect of ICA among non-insulin requiring young diabetic patients and non-diabetic controls. Therefore, autoimmune pathogenesis of beta cell killing by producing ICA against islets cell take place in young type-2 diabetic patients.
 Bangladesh Med Res Counc Bull 2020; 46(2): 104-108
Highlights
Diabetes mellitus (DM) has proved to be one of the commonest non-communicable diseases which become major public health question in the modern world
In this study statistically significant difference found between non insulin requiring young diabetic patients and non diabetic control in respect of positive islets cell auto-antibodies (ICA) result (p=0.015)
The moderately strong negative association was found between different age of onset of diabetes mellitus and value of ICA level (r=-0.45)
Summary
Diabetes mellitus (DM) has proved to be one of the commonest non-communicable diseases which become major public health question in the modern world. Autoantibodies in young diabetic patients diabetes was a disease of the first world, but it has become a major public health problem in low and middle income countries, specially affecting South Asians. Type I diabetes pathogenesis occurs primarily due to autoimmune-mediated destruction of pancreatic B-cell islets. This results absolute insulin deficiency and patients must take exogenous insulin for survival to prevent the development of ketoacidosis. Immune mediated destruction of pancreatic beta cell in type-I diabetes is well established but its’ role in young type-2 diabetic patients is still not conclusive These young diabetic patients pass through several stages where they do not need insulin but found to have serum autoantibody against islets cell and even become dependent on insulin for survival in course of time. This study aims to find the presence of islets cell auto-antibodies (ICA) and autoantibody to glutamic acid decarboxylase-65 (GAD65) in non-insulin requiring young diabetic patients of Bangladesh
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