B-cell autoantibodies in children with type 2 diabetes mellitus: subgroup or misclassification?

Thomas Reinehr ^1*, Edith Schober ², Susanna Wiegand ³, Angelika Thon ⁴ and Reinhard Holl ⁵

¹ Vestische Kinderklinik, University Witten- Herdecke, Germany
² Department of Pediatrics, University of Vienna, Austria
³ Department of Pediatrics, University of Berlin, Germany
⁴ Department of Pediatrics, University of Hannover, Germany
⁵ Department of Biostatistics, University of Ulm, Germany

^* To whom correspondence should be addressed. E-mail: tireinehr{at}aol.com.

Accepted 6 January 2006

Abstract

Objective: In adults, a fraction of diabetic individuals with b-cell autoantibodies has initially non insulin-requiring diabetes clinically appearing as type 2 diabetes mellitus (T2DM) named latent autoimmune diabetes in adulthood (LADA). The occurrence of b-cell autoantibodies in European children and adolescents with T2DM has not been reported so far.

Methods: The frequency of b-cell autoantibodies (anti-GAD, anti-IA-2, and anti-ICA) was determined in 7050 diabetic children and adolescents. The type of diabetes was classified by paediatric diabetic specialists based on the clinical presentation. Children with non-insulin dependent T2DM over a one-year period were studied separately.

Results: 6922 children were clinically classified as type 1 diabetes (T1DM) and 128 children as T2DM. 36% of the children with T2DM had at least one detectable b- cell autoantibody. These children did not differ significantly from the children with T2DM without autoantibodies in respect of age, gender, weight status, lipids, blood pressure, C-peptide, glucose, and HbA1c at manifestation, as well as frequency of anti-thyroidal antibodies and insulin treatment during follow-up. In the subgroup of the 38 children with T2DM without insulin requirement over a one-year period, autoantibodies occurred in 32%. These 12 children were predominately obese (67%), female (67%), and in pubertal age range.

Conclusion: b-cells autoantibodies were detectable in a subgroup of initially non-insulin dependent diabetic children and adolescents clinically appearing as T2DM. Following the terminology "latent autoimmune diabetes in adulthood (LADA)", this subgroup might be entitled as "LADY" (latent autoimmune diabetes in youth).

Keywords: b-cell autoantibodies, differential diagnosis, thyroidal antibodies, type 1 diabetes mellitus, type 2 diabetes mellitus

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Arch. Dis. Child. 2006 91: 455. [Extract] [Full Text] [PDF]

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