Abstract
BackgroundDiabetic patients with positive glutamic acid decarboxylase antibody (GAD-Ab) could be classified as autoimmune diabetes, which is discriminated into acute-onset classical type 1 diabetes (T1DM) and latent autoimmune diabetes in adults (LADA). However, whether the decay rate of beta cell function is relevant with the mode of onset (acute or latent-onset) is unclear. We aimed to investigate whether initial C peptide levels could help differentiate variation of C peptide decay rate.MethodsFive hundred and twenty-seven newly diagnosed GAD-Ab positive diabetic patients were followed up to assess the natural course of beta cell function. Beta cell function failure was defined as fasting C peptide and postprandial C peptide levels less than 100 pmol/L and 150 pmol/L respectively.ResultsAll these diabetic patients were discriminated according to initial fasting C peptide of 300 pmol/L, that is B+ (larger than 300 pmol/L) and B- (less than 300 pmol/L) group. The proportion of developing beta cell function failure was 13.1% in B+ group and 90.5% in B- group, which suggested that fasting C peptide levels made a good distinction of the heterogeneity in autoimmune diabetes. Receiver operator characteristic (ROC) analysis suggested that the fasting C peptide level of 300 pmol/L was optimal for determining beta cell function failure with sensitivity of 90.5% and specificity of 86.9%.ConclusionsInitial level of fasting C peptide is a good indicator for predicting beta cell function failure in GAD-Ab positive diabetic patients.
Highlights
Diabetic patients with positive glutamic acid decarboxylase antibody (GAD-Ab) could be classified as autoimmune diabetes, which is discriminated into acute-onset classical type 1 diabetes (T1DM) and latent autoimmune diabetes in adults (LADA)
Difference of beta cell function failure in acute-and latent-onset autoimmune diabetic patients We tested whether patients in T1DM and LADA had disparate progression of beta cell function
Considering the proportion of 83.7% in T1DM and 24.5% in LADA progressed to beta cell failure, the results showed that initial serum FCP level made a better distinction of the heterogeneity in autoimmune diabetes than WHO recommendation with LADA sub-typing
Summary
Diabetic patients with positive glutamic acid decarboxylase antibody (GAD-Ab) could be classified as autoimmune diabetes, which is discriminated into acute-onset classical type 1 diabetes (T1DM) and latent autoimmune diabetes in adults (LADA). Glutamic acid decarboxylase antibody (GAD-Ab) is the most widely used and the most valuable autoimmune markers in diagnosing autoimmune diabetes, especially for Chinese and adult-onset patients.[7,8]. For juvenile- and adult-onset autoimmune diabetes, the status and the titer of GAD-Ab is not so helpful [11]. To address possible predictors of the discrepancy of beta cell loss, we have conducted a prospective study to characterize the difference of 527 cases of autoimmune diabetes, who have been followed closely and assessed serum C peptide levels repeatedly. Our results indicated that initial beta cell function was the most useful marker for differentiating beta cell failure tendency in autoimmune diabetes
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