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All-Cause Mortality and Cardiovascular and Microvascular Diseases in Latent Autoimmune Diabetes in Adults

Wei, Yuxia ; Herzog, Katharina LU ; Ahlqvist, Emma LU ; Andersson, Tomas ; Nystrom, Thomas ; Zhan, Yiqiang ; Tuomi, Tiinamaija LU orcid and Carlsson, Sofia (2023) In Diabetes Care 46(10). p.1857-1865
Abstract

OBJECTIVE Latent autoimmune diabetes in adults (LADA) is a heterogenous, slowly progressing autoimmune diabetes. We aim to contribute new knowledge on the long-term prognosis of LADA with varying degrees of autoimmunity by comparing it to type 2 diabetes and adult-onset type 1 diabetes. RESEARCH DESIGN AND METHODS This Swedish population-based study included newly diagnosed LADA (n = 550, stratified into LADAlow and LADAhigh by median autoimmunity level), type 2 diabetes (n = 2,001), adult-onset type 1 diabetes (n = 1,573), and control subjects without diabetes (n = 2,355) in 2007–2019. Register linkages provided information on all-cause mortality, cardiovascular diseases (CVDs), diabetic retinopathy, nephropathy,... (More)

OBJECTIVE Latent autoimmune diabetes in adults (LADA) is a heterogenous, slowly progressing autoimmune diabetes. We aim to contribute new knowledge on the long-term prognosis of LADA with varying degrees of autoimmunity by comparing it to type 2 diabetes and adult-onset type 1 diabetes. RESEARCH DESIGN AND METHODS This Swedish population-based study included newly diagnosed LADA (n = 550, stratified into LADAlow and LADAhigh by median autoimmunity level), type 2 diabetes (n = 2,001), adult-onset type 1 diabetes (n = 1,573), and control subjects without diabetes (n = 2,355) in 2007–2019. Register linkages provided information on all-cause mortality, cardiovascular diseases (CVDs), diabetic retinopathy, nephropathy, and clinical characteristics during follow-up. RESULTS Mortality was higher in LADA (hazard ratio [HR] 1.44; 95% CI 1.03, 2.02), type 1 (2.31 [1.75, 3.05]), and type 2 diabetes (1.31 [1.03, 1.67]) than in control subjects. CVD incidence was elevated in LADAhigh (HR 1.67; 95% CI 1.04, 2.69) and type 2 diabetes (1.53 [1.17, 2.00]), but not in LADAlow or type 1 diabetes. Incidence of retinopathy but not nephropathy was higher in LADA (HR 2.25; 95% CI 1.64, 3.09), including LADAhigh and LADAlow than in type 2 diabetes (unavailable in type 1 diabetes). More favorable blood pressure and lipid profiles, but higher HbA1c levels, were seen in LADA than type 2 diabetes at baseline and throughout follow-up, especially in LADAhigh, which resembled type 1 diabetes in this respect. CONCLUSIONS Despite having fewer metabolic risk factors than type 2 diabetes, LADA has equal to higher risks of death, CVD, and retinopathy. Poorer glycemic control, particularly in LADAhigh, highlights the need for improved LADA management.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Diabetes Care
volume
46
issue
10
pages
1857 - 1865
publisher
American Diabetes Association
external identifiers
  • pmid:37635682
  • scopus:85171901184
ISSN
0149-5992
DOI
10.2337/dc23-0739
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2023 by the American Diabetes Association.
id
9468c083-1408-439d-8466-e1f07d32ef64
date added to LUP
2023-11-15 10:32:38
date last changed
2024-04-27 02:18:23
@article{9468c083-1408-439d-8466-e1f07d32ef64,
  abstract     = {{<p>OBJECTIVE Latent autoimmune diabetes in adults (LADA) is a heterogenous, slowly progressing autoimmune diabetes. We aim to contribute new knowledge on the long-term prognosis of LADA with varying degrees of autoimmunity by comparing it to type 2 diabetes and adult-onset type 1 diabetes. RESEARCH DESIGN AND METHODS This Swedish population-based study included newly diagnosed LADA (n = 550, stratified into LADA<sup>low</sup> and LADA<sup>high</sup> by median autoimmunity level), type 2 diabetes (n = 2,001), adult-onset type 1 diabetes (n = 1,573), and control subjects without diabetes (n = 2,355) in 2007–2019. Register linkages provided information on all-cause mortality, cardiovascular diseases (CVDs), diabetic retinopathy, nephropathy, and clinical characteristics during follow-up. RESULTS Mortality was higher in LADA (hazard ratio [HR] 1.44; 95% CI 1.03, 2.02), type 1 (2.31 [1.75, 3.05]), and type 2 diabetes (1.31 [1.03, 1.67]) than in control subjects. CVD incidence was elevated in LADA<sup>high</sup> (HR 1.67; 95% CI 1.04, 2.69) and type 2 diabetes (1.53 [1.17, 2.00]), but not in LADA<sup>low</sup> or type 1 diabetes. Incidence of retinopathy but not nephropathy was higher in LADA (HR 2.25; 95% CI 1.64, 3.09), including LADA<sup>high</sup> and LADA<sup>low</sup> than in type 2 diabetes (unavailable in type 1 diabetes). More favorable blood pressure and lipid profiles, but higher HbA<sub>1c</sub> levels, were seen in LADA than type 2 diabetes at baseline and throughout follow-up, especially in LADA<sup>high</sup>, which resembled type 1 diabetes in this respect. CONCLUSIONS Despite having fewer metabolic risk factors than type 2 diabetes, LADA has equal to higher risks of death, CVD, and retinopathy. Poorer glycemic control, particularly in LADA<sup>high</sup>, highlights the need for improved LADA management.</p>}},
  author       = {{Wei, Yuxia and Herzog, Katharina and Ahlqvist, Emma and Andersson, Tomas and Nystrom, Thomas and Zhan, Yiqiang and Tuomi, Tiinamaija and Carlsson, Sofia}},
  issn         = {{0149-5992}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{1857--1865}},
  publisher    = {{American Diabetes Association}},
  series       = {{Diabetes Care}},
  title        = {{All-Cause Mortality and Cardiovascular and Microvascular Diseases in Latent Autoimmune Diabetes in Adults}},
  url          = {{http://dx.doi.org/10.2337/dc23-0739}},
  doi          = {{10.2337/dc23-0739}},
  volume       = {{46}},
  year         = {{2023}},
}