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GAD Antibody Positivity Predicts Type 2 Diabetes in an Adult Population?

JohnEGreen

JohnEGreen

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Found this on the Internet don't quite know what to make of it.
Some abstracts quoted below.
"
OBJECTIVE
To evaluate the significance of GAD antibodies (GADAs) and family history for type 1 diabetes (FHT1) or type 2 diabetes (FHT2) in nondiabetic subjects.

RESEARCH DESIGN AND METHODS
GADAs were analyzed in 4,976 nondiabetic relatives of type 2 diabetic patients or control subjects from Finland. Altogether, 289 (5.9%) were GADA+—a total of 253 GADA+ and 2,511 GADA− subjects participated in repeated oral glucose tolerance tests during a median time of 8.1 years. The risk of progression to diabetes was assessed using Cox regression analysis."

"
CONCLUSIONS
GADA positivity clusters in families with type 1 diabetes or latent autoimmune diabetes in adults. GADA positivity predicts diabetes independently of family history of diabetes, and this risk was further increased with high GADA concentrations."

"Development of diabetes.
The GADA+ subjects developed diabetes significantly more often than the GADA− subjects (36/253 [14.2%] vs. 134/2,511 [5.3%], P < 0.00001), and higher GADA concentrations were associated with a higher risk (Fig. 3). Surprisingly, type 1 diabetes was diagnosed in only three male subjects aged 31–44 years. Two had been highly GADA+ 4.0 and 5.2 years earlier and the third was ICA+ and IA2ab+ at diagnosis. Altogether, 5 of the 11 (45.5%) IA2ab+ subjects developed diabetes. Except for these three type 1 diabetic patients, all the other 167 patients were diagnosed with type 2 diabetes, and they were not treated with insulin during the first year."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809967/#B12
 
No body have any views on this I for one had no idea that being GAD antibody positive could be indicative of T2. as well of T1

I don't mind showing my ignorance if it leads to enlightenment.
 
I don't think that's what the article says does it?
Are they classifying LADA as the same as Type 2?
I'm afraid not being a scientist I don't really understand what is being claimed but it doesn't seem very clear.
I'm all for precise language but that paper seems to be written in terms designed to confused the uninitiated.
 
There seem to have been a large number of GADA+ people that didn’t develop classical type 1 but were diagnosed as type 2 instead. Now what this doesn’t discuss is whether those classified as T2 were c-peptide tested, as that would have clearly distinguished between T2 and LADA.
 
tim2000s said:
There seem to have been a large number of GADA+ people that didn’t develop classical type 1 but were diagnosed as type 2 instead. Now what this doesn’t discuss is whether those classified as T2 were c-peptide tested, as that would have clearly distinguished between T2 and LADA.
Click to expand...
Hi Tim, does a C peptide test really distinguish between type 2 and LADA? I'm not so sure. I am still awaiting a definitive classification although I am not sure I am ever going to get it! I was deemed to be type 1 on presentation (low bmi, ketones, hb1a 16, 56 yrs), C peptide was done, 'low end of normal', antibodies done and only the GAD came back as positive, hurrah I thought, it's type 1 or LADA, but no they told me, the GAD is 'weak and lower than they expected', so the consultant said it could still be type 1, type 2 or LADA!!!! 7 months later, I'm off the insulin (who knows for how long), hb1a is down to 6, all readings between 3.5 and 8 and following a 60 carbs a day diet. Go figure!
 
Interesting article @JohnEGreen,

Yes indeed, it does appear that Type 2 Diabetes is increasingly being recognized as a highly heterogeneous disease.

You might be interested in this really interesting 2017 study, where Swedish and Finnish researchers identified 5 distinct T2DM clusters, each with different patient characteristics and more importantly different risk for diabetic complications:

Clustering of adult-onset diabetes into novel subgroups guides therapy and improves prediction of outcome

The following snippet is from the Abstract:

“Findings: We identified 5 replicable clusters of diabetes patients, with significantly different patient characteristics and risk of diabetic complications. Particularly, individuals in the most insulin-resistant cluster 3 had significantly higher risk of diabetic kidney disease, but had been prescribed similar diabetes treatment compared to the less susceptible individuals in clusters 4 and 5. The insulin deficient cluster 2 had the highest risk of retinopathy.”
https://www.biorxiv.org/content/early/2017/09/08/186387

The following snippet is from the article:

“Cluster 1, including 6·4% of the clustered patients (referred to as SAID, Severe Autoimmune Diabetes) was characterized by early onset, relatively low BMI, poor metabolic control, insulin deficiency, and presence of GADA (Table S2).” p.10​

Link to PDF article (43 pages): https://www.biorxiv.org/content/biorxiv/early/2017/09/08/186387.full.pdf
 
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