Abstract
BackgroundIn patients with Latent Autoimmune Diabetes in Adults (LADA) a lower body mass index was reported compared with classical type 2 diabetes (T2D), and was found to be associated with a faster progression to insulin-dependence. In this study we determined the body composition in a cohort of LADA patients from Sardinia, Italy, and compared it with age– and gender–matched patients diagnosed as having adult-onset type 1 diabetes (T1D) and non-autoimmune T2D.MethodsIn 210 LADA patients, 210 T2D patients and 30 adult-onset T1D patients of Sardinian origin we assessed total and segmental body composition (weight-adjusted percent fat mass and lean mass) by using Dual Energy X-rays Absorptiometry (DXA).ResultsIn the whole cohort of LADA patients total fat mass was significantly smaller compared with T2D patients (p < 0.0001), while no difference was found between LADA and T1D patients. In LADA men fat depletion involved all body segments, while in LADA women it was observed only in the truncal segment (p < 0.0001), as in the upper and lower regions fat deposits were larger compared to T2D (p < 0.0001). However, LADA women showed a significantly elevated truncal fat compared to T1D women (p < 0.004), whereas no difference was detected in the extremities.ConclusionsBody composition in LADA patients shows substantial difference, in a gender-dependent way, compared to classic T2D. In women fat deposits tend to accumulate in peripheral regions rather than centrally, whereas in men the distribution is more homogeneous. In addition, central fat depletion in LADA women appears to be a significant predictor of faster progression to insulin dependence. Thus, routine assessment of body composition may help the physician identify LADA patients who require early insulin treatment in order to delay beta-cell exhaustion, as well those with increased CV risk due to excess truncal adiposity.
Highlights
In patients with Latent Autoimmune Diabetes in Adults (LADA) a lower body mass index was reported compared with classical type 2 diabetes (T2D), and was found to be associated with a faster progression to insulin-dependence
Average body mass index (BMI) and waist circumference were significantly lower in LADA patients than in antibody-negative T2D (p < 0.0001) whereas they were significantly higher when compared to adult-onset type 1 diabetes (T1D) (p = 0.0002)
The frequency of metabolic syndrome in the LADA group was 88/210 (42%), that is, intermediate between that of glutamic acid decarboxylase (GADAb)–negative T2D (87%) and adultonset T1D (10%) and the differences between LADA and the other control groups were statistically significant (p < 0.001, chi–square)
Summary
In patients with Latent Autoimmune Diabetes in Adults (LADA) a lower body mass index was reported compared with classical type 2 diabetes (T2D), and was found to be associated with a faster progression to insulin-dependence. Lohmann and coworkers reported that diabetic patients with elevated GADAb titers, or presence of multiple antibodies to beta-cells (defined as “LADA–1 patients”), have lower mean BMI values and a lower prevalence of long–term complications compared with patients with a single antibody positivity and/or low titers of circulating antibodies (defined as “LADA–2 patients”) [7] In line with these findings, we recently reported, in a LADA cohort from Sardinia, a lower mean value and larger variability of BMI in comparison with T2D patients of the same ethnic origin, and we provided evidence that a BMI value below 28 kg/m2 is a strong predictor of progression towards insulindependence within 4 years [8]. We evaluated the impact of BC on the progression towards beta-cell failure
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