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

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 (CPEP or CPEP), and presence or absence of GADab (GAD or GAD). HbA, 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 (CPEP; n = 503) had higher HbA 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 GADCPEP; n = 327) and patients with type 2 diabetes (GADCPEP; n = 3544). Patients with LADA defined an intermediate group with higher HbA 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.