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MICROANGIOPATHIC COMPLICATIONS IN LATENT AUTOIMMUNE DIABETES IN ADULTS (LADA) - RELATIONSHIP WITH THYROID AUTOIMMUNITY Authors: Aura Diana Reghina1,2, Elisabeta Sava1, Suzana Florea1, Simona Fica1 1. Elias University Hospital, Endocrinology and Diabetes Department, UMF Carol Davila, Bucharest, Romania 2. National Institute of Development and Research in Pathology and Biomedical Sciences “Victor Babes”, Bucharest, Romania RESULTS

Background: Patients with LADA are a clinically, immunologically, genetically heterogeneous group and the presence of thyroid autoimmunity (TA) appears to contribute to his heterogeneity.

Aim:

Patients with TA had twice the risk of RD compared to patients without TA, odds ratios 2.27 (95% CI 0.8 la 5.7), p=0.004. %

with TA without TA

80 70

75.6

60 50

57.7

40

42.3

30 20

24.4

10 0

With RD

Without RD

The risk of NP was 1.8 times higher in patients with TA compared with patients without TA (95% CI 0.7 la 4.4; p=0.04). %

with TA without TA

The aim was to evaluate the impact of thyroid autoimmunity on microangiopathic complications in LADA patients.

100 80

76.7

60

63.6

40

36.4

20

23.3

0

Without PN

With PN

From 10 patients with DN, 4 of them (40%) had TA compared to 26 patients (27.7%) of 94 without DN. Patients with TA had the probability to develop this complication 1.7 times higher than those without TA, odds ratio 1.74 (95% CI 0.4 la 6.6, p=0.46). %

Without TA With TA

80 60

72.3 60.0

40

40.0

20

27.7

0

Without DN

With DN

Patients with TA are three times more likely to develop AN than patients without TA, odds ratio 3.4 (95% CI 1 la 11, p=0.014). %

Without TA With TA

80 60

74.7

40 20

46.2 25.3

0

Without A N

53.8

Material and method: LADA has been defined by the onset of diabetes at ages above 30 years, the lack of need for insulin therapy for at least 6 months after its first appearance, the presence of anti GAD antibodies (GADA).

Positive titers of TPOAb (anti-thyroid peroxidase antibodies ) were observed in 30 (28.8%) out of 104 LADA patients.

Prevalence of retinopathy (DR), peripheral neuropathy (PN), autonomic neuropathy (AN) and diabetic nephropathy (DN) were also evaluated.

With A N

Conclusions: Except diabetic nephropathy, the presence of thyroid autoimmunity in patients with LADA has determined a significantly higher prevalence of microangiopathic complications.

Results

LATENT AUTOIMMUNE DIABETES IN ADULTS AND METABOLIC SYNDROME Aura Reghina

1,2,3

2

2

, Elisabeta Sava , Suzana Florea , Simona Fica

1,2

1. UMF Carol Davila, Endocrinology and Diabetes Department, Bucharest, Romania 2. Elias University Hospital, Endocrinology and Diabetes Department, Bucharest, Romania e of Development and Research in Pathology and Biomedical Sciences “Victor Babeș”, Bucharest, Romania

3.

234 PATIENTS

88.4 %

55.55 %

59.6 %

44.45 %

TYPE 2DM 104 LADA PATIENTS

LADA

130 TYPE 2 DM PATIENTS 57 47

PREVALENCE OF METABOLIC SYNDROME

CHARACTERISTIC

LADA

AGE (YEARS)

44.03 +/− 10.13

49.7 +/− 9.7

p = 0.002

DIABETES SPAN (YEARS)

6.5 +/− 4.15

9.2 +/− 5.1

p = 0.001

HDL - CHOLESTEROL (mg/dl)

47.78 +/− 14.34

40.3 +/− 19.78

p = 0.001

TRIGLYCERIDES ( mg/dl)

168.25 +/− 113.10

188.5 +/− 108.2

p = 0.024

133.7 +/− 24.35

141.44 +/− 20.67

p = 0.009

SYSTOLIC BLOOD PRESSURE (mmHg)

Intr

68 62

and aim

LADA is a form of autoimmune d i a b e t e s w i t h features overlapping type 1 and type 2 diabetes mellitus (type 2 DM) with slower decline of beta cell and insufficiently described. The aim of the study was to evaluate metabolic syndrome prevalence and components in LADA versus type 2 ts. diabetes pa

Material and method

Using a previously validated clinical screening tool, we selected 234 diabe pa ents. According to pancrea c ts into autoimmunity we assign pa two groups: 104 (57 female/47 male) LADA pa ts and 130 (68 female/62 ts. Clinical male) type 2 diabetes pa and laboratory data were obtained: weight, abdominal circumference, blood pressure, triglycerides, HDL-cholesterol.

Presence of metabolic syndrome was evaluated according NCEP/ATP III criteria.

TYPE 2 DM

Results

Age at the onset of diabetes was 44.03±10.13 in LADA versus 49.7±9.7 in type 2 DM (p=0.002), and diabetes span was 6.5±4.15 vs 9.2±5.1 (p=0.001). In LADA group vs type 2 DM group we obtained following mean values: HDL cholesterol 47.78±14.34 vs 40.3±19.78 (p=0.001), triglycerides 168.25±113.10 vs 188.5±108.2 (p=0.024), systolic blood pressure 133.7±24.35 vs 141.44±20.67 (p=0.009). The prevalence of metabolic syndrome was 59.6% in LADA versus 88.4% in type 2 DM.

P

Conclusion

Prevalence of metabolic syndrome was lower in LADA pa ents versus type 2 diabetes ts. Even thou LADA pa ts pa were younger, the prevalence of metabolic syndrome s remained significantly lower a er adjustment ts had lower for age. LADA pa cardiovascular risk comparing to ts. type 2 diabetes pa

Key words: autoimmune diabetes, metabolic syndrome.

LATENT AUTOIMMUNE DIABETES IN ADULTS AND METABOLIC SYNDROME Aura Reghina1,2,3, Elisabeta Sava2, Suzana Florea2, Simona Fica1,2

1. UMF Carol Davila, Endocrinology and Diabetes Department, Bucharest, Romania 2. Elias University Hospital, Endocrinology and Diabetes Department, Bucharest, Romania e of Development and Research in Pathology and Biomedical Sciences “Victor Babeș”, Bucharest, Romania

3.

55.55 %

234 PATIENTS

CHARACTERISTIC

LADA

TYPE 2 DM

P

AGE (YEARS)

44.03 +/− 10.13

49.7 +/− 9.7

p = 0.002

DIABETES SPAN (YEARS)

6.5 +/− 4.15

9.2 +/− 5.1

p = 0.001

HDL - CHOLESTEROL (mg/dl)

47.78 +/− 14.34

40.3 +/− 19.78

p = 0.001

TRIGLYCERIDES ( mg/dl)

168.25 +/− 113.10

188.5 +/− 108.2

p = 0.024

SYSTOLIC BLOOD PRESSURE (mmHg)

133.7 +/− 24.35

141.44 +/− 20.67

p = 0.009

44.45 %

TYPE 2DM LADA

104 LADA PATIENTS

Intr

57 47

68 62

Material and method

and aim

LADA is a form of autoimmune diabetes with features overlapping type 1 and type 2 diabetes mellitus (type 2 DM) with slower decline of beta cell and insufficiently described. The aim of the study was to evaluate metabolic syndrome prevalence and components in ts.

LADA versus type 2 diabetes pa

130 TYPE 2 DM PATIENTS

Using a previously validated clinical screening tool, we selected 234 diabe pa ents. According to pancrea c ts into two autoimmunity we assign pa groups: 104 (57 female/47 male) LADA ts and 130 (68 female/62 male) type 2 pa diabetes pa ents. Clinical and laboratory data were obtained: weight, abdominal circumference, blood pressure, triglycerides, HDL-cholesterol. Presence of metabolic syndrome was evaluated according NCEP/ATP III criteria.

„ACKNOWLEDGEMENT: This paper is partly supported by the Sectorial Opera

Results Age at the onset of diabetes was 44.03±10.13 in LADA versus 49.7±9.7 in type 2 DM (p=0.002), and diabetes span was 6.5±4.15 vs 9.2±5.1 (p=0.001). In LADA group vs type 2 DM group we obtained following mean values: HDL cholesterol 47.78±14.34 vs 40.3±19.78 (p=0.001), triglycerides 168.25±113.10 vs 188.5±108.2 ( p = 0 . 0 2 4 ) , sy s t o l i c b l o o d p re s s u re 133.7±24.35 vs 141.44±20.67 (p=0.009). The prevalence of metabolic syndrome was 59.6% in LADA versus 88.4% in type 2 DM.

Conclusion Prevalence of metabolic syndrome ts versus type was lower in LADA pa 2 diabetes pa ents. Even thou LADA ts were younger, the prevalence of pa metabolic syndrome s ll remained significantly lower a er adjustment for age.

LADA p ents had lower cardiovascular ts. risk comparing to type 2 diabetes pa

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