Metabolic risk profiles in diabetes stratified according to age at onset, islet autoimmunity and fasting C-peptide

Published:October 05, 2017DOI:https://doi.org/10.1016/j.diabres.2017.09.014

      Highlights

      • Method for stratifying diabetes into groups with differences in cardiometabolic risk is proposed.
      • Age at onset is not useful in stratifying diabetes into these groups.
      • Fasting C-peptide and GADab define groups with relevant differences in cardiometabolic risk.
      • Groups are defined as insulin deficient diabetes, LADA and type 2 diabetes mellitus.

      Abstract

      Objective

      Islet autoimmunity, age at onset and time to insulin treatment are often used to define subgroups of diabetes. However, the latter criterion is not clinical useful. Here, we examined whether an unbiased stratification of diabetes according to age at onset, fasting C-peptide and GAD autoantibodies (GADab) defines groups with differences in glycaemic control and markers of cardiometabolic risk.

      Design and methods

      A cohort of 4374 adults with relatively newly diagnosed diabetes referred to a Danish hospital during 1997–2012 was stratified according to age at onset above or below 30 years, fasting C-peptide above or below 300 pmol/l (CPEPhigh or CPEPlow), and presence or absence of GADab (GADpos or GADneg). HbA1c, BMI, blood pressure (BP), lipid profile, alanine aminotransferase (ALT) and creatinine were evaluated.

      Results

      GADab were present in 13% of the cohort. Age at onset was not associated with major differences between groups. Patients with insulin deficient diabetes (CPEPlow; n = 503) had higher HbA1c but otherwise lower cardiometabolic risk (lower BMI, BP, LDL, triacylglycerol, and ALT, and higher HDL) than both patients with latent autoimmune diabetes of adults (LADA defined as GADposCPEPhigh; n = 327) and patients with type 2 diabetes (GADnegCPEPhigh; n = 3544). Patients with LADA defined an intermediate group with higher HbA1c but otherwise lower cardiometabolic risk than patients with type 2 diabetes.

      Conclusions

      Our results demonstrate that fasting C-peptide and GADab status, but not age at onset, define groups of patients with diabetes with clinically relevant differences in glycaemic control and cardiometabolic risk.

      Keywords

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