Islet cell antibodies and glutamic acid decarboxylase antibodies, but not the clinical phenotype, help to identify type 1 1/2 diabetes in patients presenting with type 2 diabetes

Rattan Juneja, I. B. Hirsch, R. G. Naik, B. M. Brooks-Worrell, C. J. Greenbaum, J. P. Palmer

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Abstract

This study was undertaken to determine which type 1 diabetes-associated autoantibodies and what clinical characteristics are most useful to identify patients with type 1 1/2 diabetes. We studied 125 patients, recently diagnosed clinically with type 2 diabetes for the presence of islet cell antibodies (ICA), insulin autoantibodies (IAA), antibodies to glutamic acid decarboxylase(GADAb), and IA-2a (IA-2Ab). Patients with a diagnosis of type 2 diabetes who met all of the following criteria at diagnosis were studied: age ≥ 30 years, no history of ketonuria or ketoacidosis, and not requiring insulin treatment. Thirty-six patients (29%) were positive for at least 1 antibody. Thirty-two (26%) were ICA positive and 20 (16%) GADAb positive. Insulin autoantibodies and IA-2Ab occurred less frequently in 2 (1.6%) and 8 (6.4%) patients, respectively. There was no significant difference in the ages at diagnosis between the Ab(+) and Ab(-) patients, age in years (range) 47.2 (32 to 64) versus 51.2 (31 to 77), respectively, P = .06. Body mass index (BMI) was different in the 2 groups, with Ab(+) patients being less obese, BMI (range) 28.3 kg/m2 (17.6 to 54.9) versus 32.0 kg/m2 (19.2 to 68.8), respectively, P = .01. Clinical presentation of diabetes was more commonly symptomatic with polyuria and polydipsia in Ab(+) patients, while in Ab(-) patients, diagnosis was more often incidental, P = .002. However, more than 95% of patients overlapped in both age and BMI irrespective of antibody status. Similarly, 42% of Ab(+) patients had their diabetes diagnosed incidentally, while 29% of Ab(-) patients presented with polyuria and polydipsia. We therefore conclude that screening with antibodies, mainly ICA and GAD, but not age, BMI, or clinical presentation should be used to identify type 1 1/2 diabetes.

Original languageEnglish (US)
Pages (from-to)1008-1013
Number of pages6
JournalMetabolism: Clinical and Experimental
Volume50
Issue number9
DOIs
StatePublished - 2001
Externally publishedYes

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Glutamate Decarboxylase
Type 2 Diabetes Mellitus
Phenotype
Antibodies
Body Mass Index
Autoantibodies
Polydipsia
Polyuria
Ketosis
islet cell antibody
Insulin
Insulin Antibodies
Type 1 Diabetes Mellitus

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Islet cell antibodies and glutamic acid decarboxylase antibodies, but not the clinical phenotype, help to identify type 1 1/2 diabetes in patients presenting with type 2 diabetes. / Juneja, Rattan; Hirsch, I. B.; Naik, R. G.; Brooks-Worrell, B. M.; Greenbaum, C. J.; Palmer, J. P.

In: Metabolism: Clinical and Experimental, Vol. 50, No. 9, 2001, p. 1008-1013.

Research output: Contribution to journalArticle

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abstract = "This study was undertaken to determine which type 1 diabetes-associated autoantibodies and what clinical characteristics are most useful to identify patients with type 1 1/2 diabetes. We studied 125 patients, recently diagnosed clinically with type 2 diabetes for the presence of islet cell antibodies (ICA), insulin autoantibodies (IAA), antibodies to glutamic acid decarboxylase(GADAb), and IA-2a (IA-2Ab). Patients with a diagnosis of type 2 diabetes who met all of the following criteria at diagnosis were studied: age ≥ 30 years, no history of ketonuria or ketoacidosis, and not requiring insulin treatment. Thirty-six patients (29{\%}) were positive for at least 1 antibody. Thirty-two (26{\%}) were ICA positive and 20 (16{\%}) GADAb positive. Insulin autoantibodies and IA-2Ab occurred less frequently in 2 (1.6{\%}) and 8 (6.4{\%}) patients, respectively. There was no significant difference in the ages at diagnosis between the Ab(+) and Ab(-) patients, age in years (range) 47.2 (32 to 64) versus 51.2 (31 to 77), respectively, P = .06. Body mass index (BMI) was different in the 2 groups, with Ab(+) patients being less obese, BMI (range) 28.3 kg/m2 (17.6 to 54.9) versus 32.0 kg/m2 (19.2 to 68.8), respectively, P = .01. Clinical presentation of diabetes was more commonly symptomatic with polyuria and polydipsia in Ab(+) patients, while in Ab(-) patients, diagnosis was more often incidental, P = .002. However, more than 95{\%} of patients overlapped in both age and BMI irrespective of antibody status. Similarly, 42{\%} of Ab(+) patients had their diabetes diagnosed incidentally, while 29{\%} of Ab(-) patients presented with polyuria and polydipsia. We therefore conclude that screening with antibodies, mainly ICA and GAD, but not age, BMI, or clinical presentation should be used to identify type 1 1/2 diabetes.",
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