Objectives: Few studies have examined the progression to chronic complications in patients with latent autoimmune diabetes in adults (LADA). We compared incidence of cardiovascular-renal diseases, severe hypoglycaemia and death in patients with LADA and type 2 diabetes.
Methods: Between 1995-2012, 1569 Chinese with young-onset (age of diagnosis <40 years) non-type 1 diabetes underwent comprehensive disease assessment at Prince of Wales Hospital, Hong Kong. LADA (n=124 [7.9%]) was identified by positive anti-glutamic acid decarboxylase antibodies measured from stored serum. Patients were followed for new events of cardiovascular disease (CVD), end-stage renal disease (ESRD), severe hypoglycaemia and all-cause death until June 2017.
Results: At baseline, patients with LADA (mean age: 43.4 years, median diabetes duration: 6.0 years) had lower serum C-peptide, BMI and triglyceride but higher HbA1c than patients with type 2 diabetes (mean age: 41.7 years, median diabetes duration: 8.0 years). Use of insulin was more frequent in those with LADA whilst use of non-insulin glucose lowering drugs was comparable. Over follow-up period of 10 years, incidence (in 1000 person-year) of CVD, ESRD, severe hypoglycaemia and death were 4.1, 8.0, 20.2 and 5.5 in LADA, and 10.4, 9.5, 10.8 and 8.8 in type 2 diabetes, respectively. Using Cox regression, patients with LADA had lower hazard to have CVD (hazard ratio [HR] 0.41 [95% CI 0.19-0.89], p=0.024), higher hazard to have severe hypoglycaemia (HR 1.74 [95% CI 1.15-2.62], p=0.008) and similar risks for ESRD and mortality compared with type 2 diabetes, adjusted for age, gender, disease duration, smoking, glycaemic and metabolic indices, and baseline insulin use.
Conclusions: Patients with LADA had lower risks of CVD but higher risks of severe hypoglycaemia than type 2 diabetes.
A. Luk: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc.. Research Support; Self; Sanofi. E.S. Lau: None. C.K.P. Lim: None. E. Chow: Research Support; Self; Sanofi. R.C. Ma: Research Support; Self; AstraZeneca, Bayer AG, Merck Sharp & Dohme Corp., Pfizer Inc.. Advisory Panel; Self; Boehringer Ingelheim GmbH, Nippon Boehringer Ingelheim Co. Ltd. A.P. Kong: Research Support; Self; AstraZeneca. J.C. Chan: Consultant; Self; Bayer AG. Other Relationship; Self; Bayer AG. Consultant; Self; Sanofi. Other Relationship; Self; Sanofi, Eli Lilly and Company, Amgen Inc.. Consultant; Self; AstraZeneca, Merck & Co., Inc., Pfizer Inc.. Other Relationship; Self; Pfizer Inc.. Board Member; Self; Asia Diabetes Foundation. Stock/Shareholder; Self; GemVCare. Other Relationship; Self; Merck Sharp & Dohme Corp.. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novartis AG, Eli Lilly and Company.