Clinical and Genetic Heterogeneity of Latent Autoimmune Diabetes in Adults: Response to Fukui et al (original) (raw)

Ethnic Differences in Diabetes Symptoms Among People Without Known Diabetes in New Zealand

Diabetes Care, 2003

A lthough the number of children and youth with type 2 diabetes is increasing, a clear case definition that describes children with type 2 diabetes at presentation remains elusive. Most initial diagnoses are decided on the clinical picture at presentation (1). Characteristics and risk factors have been outlined in several review and clinical articles (2-4). The purpose of this study was to describe the characteristics of youth presenting for an initial visit to the outpatient clinic of a large tertiary children's care center and diagnosed with type 2 diabetes.

Diabetic autoimmune markers in children and adolescents with type 2 diabetes

Pediatrics, 2001

Background. There is an increase in the incidence of type 2 diabetes in children and adolescents. Absence of known diabetes autoimmune markers is sometimes required to confirm the diagnosis. Objective. To identify clinical and autoimmune characteristics of type 2 diabetes in a pediatric population. Method. We report an analysis of 48 children and adolescents with type 2 diabetes, compared with 39 randomly selected children with type 1 diabetes, diagnosed and followed at the Loma Linda University Pediatric Diabetes Center. Ethnic, familial, seasonal, and autoimmune marker characteristics are outlined. To determine the reliability of antibody testing in confirming the type of diabetes at diagnosis, we studied the incidence of positive islet cell antibodies (ICAs), glutamic acid decarboxylase antibodies (GADs), and insulin autoantibodies (IAAs) at diagnosis in both groups. ICA512, GADs, and IAAs were measured by radioimmunoassay. Results. The cohort with type 2 diabetes had a similar gender distribution as the group with type 1 diabetes but a significantly higher age at diagnosis. Ethnic background was significantly different between the 2 groups, predominantly Hispanic in type 2 and white in type 1. Body mass index was significantly higher in type 2 diabetes (mean ‫؍‬ 31.24 kg/m 2). Among the patients with type 2 diabetes, 33% presented in diabetic ketoacidosis, random blood glucose at diagnosis ranged from 11.4 to 22.25 mmol/L (228-445 mg/dL), fasting C-peptide levels ranged from 0.89 to 2.7 nmol/L (2.7-8.2 ng/mL; normal: <1.36 nmol/L), and hemoglobin A 1C was 10.8 ؎ 3.5% (normal: <6.6%). None of these parameters was significantly different from the type 1 diabetes group. Although the incidence of diabetes antibody markers was significantly lower in type 2 versus type 1 diabetes, 8.1% of patients with type 2 diabetes had positive ICAs, 30.3% had positive GADs, and 34.8% had positive IAAs without ever being treated with insulin. In the type 2 diabetes group, none of the Hispanic patients had ICAs. However, there was no significant correlation between any of the diabetes antibodies and obesity, presence of acanthosis nigricans, or family history of diabetes. The frequency of thyroid antibodies was not significantly different from the group with type 1 diabetes. Daily insulin requirements 1 year after diagnosis were significantly lower in type 2 diabetes, ranging from 0 to 1.2 U/kg with a mean of 0.33. Conclusion. Absence of diabetes autoimmune markers is not a prerequisite for the diagnosis of type 2 diabetes in children and adolescents. Pediatrics 2001;107(6). URL: http://www.pediatrics.org/cgi/content/full/107/6/ e102; type 2 diabetes, adolescents, autoimmunity, islet cell antibodies, glutamic acid decarboxylase antibodies.

Type 1 Diabetes versus Type 2 Diabetes with Onset in Persons Younger than 20 Years of Age

Annals of The New York Academy of Sciences, 2008

Type 1 diabetes (T1D) is the most common form of diabetes in children in Western countries. There have been no large studies of childhood diabetes from India. We undertook the MEDI study (Multicenter Survey of Early Onset Diabetes in India) to assess the proportion of various subtypes of diabetes among the young subjects presenting to the endocrinology divisions of seven large teaching hospitals in different regions of India. In addition, we compared the clinical features of T1D and type 2 diabetes (T2D) in Indian subjects. Patients with onset of disease at younger than 20 years of age were included in this study. Six hundred and three subjects (603) were studied of whom 535 subjects (89%) had T1D, 36 (6%) had T2D, 18 (3%) had diabetes related to tropical pancreatitis or other forms of chronic pancreatitis, while other subtypes accounted for the rest. Compared to those with T2D, subjects with T1D were younger, had a lower C-peptide level, higher prevalence of ketosis, lower prevalence of acanthosis nigricans, and lower LDL and triglyceride levels. When compared with that of T2D, a higher proportion of patients with T1D were positive for GAD-65 and IA-2 antibodies, and this difference was statistically significant for GAD-65 antibodies. Overall, this large multicenter study showed that T1D is the commonest form of diabetes in childhood. T2D is the next most common kind, while chronic pancreatitis-related diabetes is uncommon.

Clinical Profile of Diabetes Mellitus in Children and Adolescents under Eighteen Years of Age

Ibrahim Medical College Journal, 2009

A total number of 125 patients with diabetes mellitus (DM) under eighteen years of age were admitted in the Paediartic department of BIRDEM hospital between January 2001 to October 2002. Eighty-eight patients (71%) were newly detected. Female to male ratio was 3:1. Out of the total admission 38 (30.4%) patients had type 1 DM (group 1), 37 (29.6%) patients had fibrocalculous pancreatic FCPD diabetes (group II), 48 (38.4%) patient had malnutrition modulated diabetes mellitus MMDM (group III) and 2 (1.6%) patients had type 2. Mean age of onset was 9±3.9 yrs in group I and 13±2.3 yrs in group II and group III. All groups had very high glucose and HbA1c value at presentation. The mean fasting glucose (mmol/l) was 19±7.14, 22.39±9 and 19.54±7.9 in group I, group II and group III respectively. The Mean HbA1c (%) value in the three groups was 14.4±2.7, 16.72±2.26 and 15.27±3.05 respectively. FCPD patients had poorest glycaemic status. Acute complications were more common in type 1 patients. Twelve (31.5%) patients had diabetic ketoatin DKA and two (5%) patients had hypoglycaemia in group I. Chronic complications were present in all three groups. MMDM patients had highest rate of complications. which was present in 2.6%, 21.6% and 33.3% patients in group I, group II and group III respectively. The rate of microalbuminuria was 5.3%. 10.8% and 18.8% in the three groups respectively. The rate of neuropathy was 2.6%, 16.2% and 20.8% in the three groups respectively. Among the associated problems skin infection, pulmonary tuberculosis and bilateral parotid swelling were common. Malnutrition was present in 66%, 86% and 100% in group I, group II and group III respectively. Majority (50% in group I, 91.6% in group II and 100% in group III) of our patients came from poor socio-economic background.