A systematic review and meta-analysis to compare the prevalence of depression between people with and without Type 1 and Type 2 diabetes

AimsDiabetes can significantly impact quality of life and mental health. However, inconsistencies have been reported in the prevalence of depression in those with Type 1 and Type 2 diabetes, and those without. Systematic reviews also included studies without adequate control subjects. We update existing literature, by comparing depression prevalence between individuals with and without Type 1 and Type 2 diabetes.MethodsA systematic review and meta-analysis. We searched MEDLINE, EMBASE and PSYCHINFO, from January 1985 to August 2021. Studies were excluded if they failed to have an adequate control group, specified type of diabetes, or reported depression prevalence by type of diabetes.Results44 studies were selected for inclusion. The prevalence of depression was significantly higher in people with Type 1 (22% vs 13%, OR = 2.10 (95% CI: 1.23, 3.52)), or Type 2 diabetes (19% vs 11%, OR = 1.76 (1.55, 2.01)) compared to those without diabetes. There was no association between study effect size and mean age or gender. Findings did not significantly differ between methods of depression assessment. Prevalence of depression in people with diabetes was higher in studies carried out in specialist care (36%, OR = 3.14 (2.12, 4.63)) compared to those in community or primary care (12%, OR = 1.51 (1.35, 1.70) and in low- and middle-income countries (OR = 2.58 (1.91, 3.50) compared to countries with high income economies (OR = 1.59 (1.39, 1.82)).ConclusionsDepression prevalence remains significant in those with type 1 and type 2 diabetes. Effective chronic disease management in people with diabetes is important, particularly screening and managing depression and diabetes distress in specialist care settings.     

Family histories of diabetes among Japanese patients with Type 1 (insulin-dependent) and Type 2 (non-insulin-dependent) diabetes

Summary Family histories of diabetes mellitus in first-degree relatives were compared in Japanese patients with Type 1 (insulin-dependent) and Type 2 (non-insulin-dependent) diabetes. The frequency of positive family histories for diabetes in first-degree relatives was 24% (13/55) in Type 1, 44% (281/631) in Type 2 (p<0.01 versus Type 1) and 47% (16/34) when the type of diabetes could not be classified. The prevalence of diabetes in siblings of Type 2 patients was higher than in Type 1 diabetic patients (p<0.01). Patients with Type 2 diabetes and definite obesity in the past had a lower frequency of a family history of diabetes (p<0.01) and a lower prevalence of diabetes in their parents (p<0.01) than did Type 2 patients without obesity. The highest rate of family history for diabetes was observed in non-obese Type 2 diabetic patients of early onset. Our data agree with the previously known higher frequency of familial diabetes in Type 2 compared with Type 1 diabetes, despite the fact that there are significant dissimilarities between Type 1 diabetes in Japanese and Caucasoid populations.     

Comparing diabetes due to diseases of the exocrine pancreas to type 1 and type 2 diabetes using propensity score matching

ObjectiveTo estimate the prevalence of diabetes due to diseases of the exocrine pancreas (DEP) using data of the multicentre diabetes patient follow-up registry. Moreover, we aimed at comparing individuals with diabetes due to DEP to individuals with type 1 and type 2 diabetes.MethodsIndividuals with DEP, type 1 or type 2 diabetes ≥18 years of age were studied. We aggregated the most recent treatment year per patient and used propensity scores to match diabetes due to DEP to type 1 and type 2 diabetes. Matching was conducted one-to-one with sex, age, diabetes duration, migration background and the German index of socioeconomic deprivation as covariates.ResultsWe identified 7,093 (1.6%) individuals with diabetes due to DEP. In the matched cohort DEP-type 1 diabetes we observed a similar daily insulin dose (0.62 IU/kg (95% confidence interval:0.60–0.63), 0.60 IU/kg (0.58–0.62)) and significant differences regarding microvascular (41.0% (39.7–42.2), 45.3% (44.0–46.6)), and macrovascular disease (16.6% (15.7–17.6), 14.7% (13.8–15.6)). HbA1c (8.2% (8.1–8.3), 7.9% (7.8–8.0)), daily insulin dose (0.60 IU/kg (0.58–0.62), 0.56 IU/kg (0.54–0.58)) and event rates of severe hypoglycemia (23.9 events/100 PY (21.4–26.8), (9.5 events/100 PY (8.0–11.2)) were significantly higher in individuals with diabetes due to DEP compared to type 2 diabetes.ConclusionsUsing registry data, rare diabetes types such as diabetes due to DEP can be studied with a significant sample size. Our study identified differences and similarities between adult individuals with DEP related diabetes and type 1 or type 2 diabetes.     

Apolipoprotein (a) levels in type 1 and type 2 diabetes mellitus

Type 1 and type 2 diabetes mellitus are both characterized by increased cardiovascular mortality and morbidity. Since several reports have indicated that apolipoprotein (a) [apo (a)] levels are positively associated with an increased risk of macrovascular disease, we investigated whether apo (a) levels are elevated in both types of diabetes mellitus and may thus represent an independent risk factor for atherosclerotic disease. Apo(a) concentrations in type 1 diabetic patients were not significantly different from matched controls (276±78 vs 149±46 units/l). Type 2 diabetic patients had considerably higher levels of apo (a) than matched controls (471±89 vs 221±61 units/l,P=0.06), though the difference was not statistically significant. However, concentrations of apo (a) were above 300 units/l in 36% of type 1 and 67% of type 2 diabetic patients, but in only 14% and 25% respectively of matched control subjects. Plasma triglycerides were positively and independently correlated with apo (a) levels in both diabetic and non-diabetic subjects. On the other hand, no significant correlation was found between apo (a) levels and glycosylated haemoglobin, total cholesterol or high density lipoprotein cholesterol in any of the groups studied. In conclusion, apo (a) levels are not significantly elevated either in type 1 or type 2 diabetic patients without proteinuria and in moderate metabolic control; however, levels above 300 units/l were 2.6 times more frequent in both types of diabetes mellitus than in carefully age-, sex-, and weight-matched control subjects.     

Sex- and BMI-related differences in risk factors for coronary artery disease in patients with type 2 diabetes mellitus

There are contrasting data about the relationship between obesity and macrovascular complications in type 2 diabetes mellitus, and it is not known if risk factors for coronary artery disease are different in normal weight and overweight or obese patients. All 2113 patients with type 2 diabetes mellitus referring to the Diabetic Clinic of Asti were studied. Patients were divided into tertiles of body mass index, according to their sex (BMI < 26.9; ≥ 26.9 and < 31.4; ≥ 31.4 kg/m² for females and BMI < 25.7; ≥ 25.7 and < 28.8; ≥ 28.8 kg/m² for males). Age, BMI, duration of diabetes, blood pressure, HbA_1c total cholesterol, HDL-cholesterol, LDL-cholesterol, and prevalence of insulin treatment and hypertension were higher in females, whereas exercise, alcohol intake, smoking habits and prevalence of dyslipidemia were higher in males. An increase in BMI was associated with an increase in HbA_1c, number of cigarettes/day, blood pressure, triglycerides, C-peptide, prevalence of hypertension and dyslipidemia, and with a decrease in age, duration of diabetes and HDL-cholesterol values. In spite of an apparently worse cardiovascular risk profile, females showed a 50% lower prevalence of CAD than males and the prevalence of CAD was not significantly different in obese compared to other BMI categories. Multiple logistic regression showed that risk factors for CAD were different in males and females and similar in the lower tertiles of BMI, while different in the highest. In obese females, risk factors for CAD were age, reduced HDL-cholesterol and increased HbA_1c levels; in males they were years of smoking and duration of diabetes. These data suggest that in type 2 diabetes, risk factors for CAD are different in the two sexes and in patients with the highest BMI compared to the normal and overweight subjects; blood glucose control and duration of diabetes seem more important than conventional cardiovascular risk factors in obese patients. Received: 11 May 1998 / Accepted in revised form: 30 July 1999     

Contribution of obesity in increasing type 2 diabetes prevalence in Iranian urban and rural adults during recent decade

Background and ObjectivesThe prevalence of both obesity and type 2 diabetes has increased in recent years. In this study, we aimed to evaluate the prevalence of obesity and type 2 diabetes and to investigate the contribution of obesity to the increased prevalence of type 2 diabetes in urban and rural Iranian communities.MethodsThis study was based on four surveys from the Surveillance Survey of Risk Factors of Non-communicable Diseases (SuRFNCD), conducted in 2005, 2007, 2011, and 2016. The contribution of general and abdominal obesity to the prevalence of type 2 diabetes was determined based on the population attributable fraction (PAF).ResultsThe mean (95% CI) age and body mass index (BMI) of the participants were 36.9 years (36.8–36.9) and 25.9 kg/m² (25.9–26.0), respectively. The increasing rates of general obesity and diabetes were 37% and 80% among urban residents and 63% and 68% among rural residents, respectively. The PAF of general obesity and abdominal obesity to the prevalence of type 2 diabetes was 20.2% and 33.4% in urban residents and 11.8% and 21.0% in rural residents, respectively.ConclusionThe prevalence of both obesity and type 2 diabetes has increased over the past 12 years. Besides, general and abdominal obesity played a substantial role in increasing the prevalence of type 2 diabetes in both urban and rural populations.     

Autoantibodies to glutamic acid decarboxylase in diabetic patients from a multi-ethnic Australian community: the Fremantle Diabetes Study.

AIMS: To investigate ethnic/racial differences in the prevalence of serum antibodies to glutamic acid decarboxylase (GADA) and ICA512/IA-2 in diabetic patients from a large, urban community. METHODS: A cross-sectional sample of 1,381 diabetic patients aged 11-98 years, representing 61% of those identified in a postcode-defined population base of 120,097 people were studied. Diabetes was classified on clinical grounds. Serum GADA and anti-ICA512/IA-2 were measured by radioimmunoprecipitation assay. RESULTS: Anglo-Celts formed 62% of the sample, southern Europeans 18%, other Europeans 8% and Asians 3%. GADA prevalence in Type 1 and Type 2 diabetes mellitus was 46.0% and 4.2%, respectively, amongst Anglo-Celts and 22.2% and 1.7% in southern Europeans. The prevalence of anti-ICA512/IA-2 in Type 1 diabetes was 17.4% and, in a sample of 233 patients with Type 2 diabetes, 0.8%. GADA-positive Type 2 patients had a lower body mass index and greater glycosylated haemoglobin, and were more likely to be taking insulin, than GADA-negative Type 2 diabetic subjects (P < 0.05), consistent with the phentoype of latent autoimmune diabetes of adults (LADA). In both Type 1 and Type 2 diabetes, there was a strong inverse association between GADA and serum triglycerides (P < 0.001). CONCLUSIONS: The relatively low GADA prevalence in Anglo-Celt patients with Type 1 diabetes is a feature of this community-based study and suggests that GADA levels do fall with time, given the older age of the sample and a relatively long period between diagnosis and sampling. Southern Europeans had an even lower GADA prevalence, regardless of diabetes type. Variations in GADA frequency in diabetic patients of differing European ethnicity has implications for clinical management and healthcare planning.     

高尿酸血症和2型糖尿病在代谢综合征中的作用

目的评价高尿酸血症和2型糖尿病(T2DM)在代谢综合征(MS)中的作用，并探讨其可能的作用机制。方法对124例高尿酸血症和56例血尿酸正常的T2DM患者的临床资料进行研究。结果高尿酸血症合并糖尿病组的体质指数(BMI)、甘油三酯(TG)以及冠心病和高血压病的患病率高于血糖正常组，且BMI、总胆固醇(TC)、TG以及冠心病和高血压病的患病率明显高于尿酸正常对照组。结论(1)高尿酸血症与肥胖、血脂异常明显相关。(2)高尿酸血症加重了T2DM患者的代谢紊乱，T2DM也使高尿酸血症患者的代谢紊乱加重，两者共同促进了动脉粥样硬化及冠心病和高血压病的发生。     

Abnormal liver function tests in patients with Type 1 diabetes mellitus: prevalence,clinical correlations and underlying pathologies

Aims To determine the prevalence of elevated alanine transaminase (ALT) in a large cohort of patients with Type 1 diabetes and to examine the clinical correlations and causes. Methods Patients with Type 1 diabetes mellitus were prospectively recruited and ALT, glycated haemoglobin and lipid profile were measured. Patients with Type 2 diabetes mellitus were recruited as a comparison group. Patients with abnormal ALT were investigated for underlying causes. Prevalence of abnormal ALT was analysed at three separate cut‐offs and multivariable analysis used to identify independent risk factors. Results Nine hundred and eleven with Type 1 diabetes and 963 with Type 2 diabetes were included. The prevalence of elevated ALT was dependent on the cut‐off value: > 30 IU/l in males and > 19 IU/l in females, > 50 and > 63 IU/l was 34.5, 4.3 and 1.9%, respectively, in Type 1 diabetes and 51.4, 8.2 and 3.7%, respectively, in Type 2 diabetes. In Type 1 diabetes an elevated ALT was associated with worse glycaemic control, age > 55 years and elevated triglycerides. Investigation of these patients revealed a cause in 43.6% of patients, predominantly non‐alcoholic fatty liver disease (NAFLD). Conclusions Elevated ALT is not uncommon in Type 1 diabetes and is associated with NAFLD‐related risk factors. Patients with Type 1 diabetes and elevated ALT should be investigated as significant abnormalities may be found which are amenable to interventions.     

Chronic kidney disease prevalence and cardiovascular risk in a cohort of patients with type 2 diabetes followed for 10 years in Badajoz (Spain). An observational study

AimsTo estimate the prevalence of chronic kidney disease (CKD), their risk factors the incidence of cardiovascular and coronary events and total and cardiovascular mortality in a cohort of type 2 diabetes (T2DM) patients observed for 10 years in primary care practices in Badajoz, Spain.MethodsObservational, longitudinal study. A total of 643 patients with T2DM (mean age 64.0 years, 55.7% women), without evidence of cardiovascular disease, were studied. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m² at the beginning of the study, by applying the simplified Modification of Diet in Renal Disease (MDRD) Study formula.ResultsThe prevalence rate of CKD was 24.3%. Patients with CKD had higher percentages of coronary, cerebrovascular and cardiovascular events and higher rates of cardiovascular mortality (18.6 vs. 6.0%, p < 0.001) and total mortality (42.3 vs. 23.4%, p < 0.01), compared to patients without CKD. The Cox proportional hazards model, adjusted for age, systolic blood pressure levels, glycated haemoglobin, total cholesterol, obesity and smoking, revealed that patients with CKD had an increased risk of coronary events (HR:2.18; 95% CI:1.13?4.22, p < 0.05).ConclusionsOur study confirms a high prevalence of CKD in patients with T2DM and its relationship with the presence of cardiovascular disease.     

Prevalence of sarcopenia in sample of Iraqi patients with type 2 diabetes mellitus: A hospital based study

Background and aimsDamage to the skeletal muscles, with a pronounced and accelerated decline in muscle quality have been described as a new complication of diabetic patients, so this study was conducted to assess the prevalence of sarcopenia in sample of Iraqi patients with type 2 diabetes mellitus.MethodsThis was a case-control study conducted at Baghdad Teaching Hospital from September 2018 to April 2019. Participants were men and women aged between (40–70) years with type 2 diabetes mellitus diagnosed by an Internist/Endocrinologist doctor and on treatment for at least 6 months earlier. Sixty-five patients and 65 matched healthy controls in age, gender and body mass index were studied. Diagnosis of sarcopenia was done according to revised European consensus on the definition and diagnosis of sarcopenia 2018. Glycemic control was evaluated by mean of hemoglobin A1c (HbA1c) test.ResultsThe mean age of the patients was 57.0 ± 7.7 years, and mean disease duration was 7.2 ± 6.0 years. The prevalence of sarcopenia was 10 (15.4%) in diabetic patients and 5 (7.7%) in controls while the prevalence of presarcopenia was 7 (10.8%) in diabetic patients and 3 (4.6%) in controls (p-value = 0.133).: The mean age of the patients was 57.0 ± 7.7 years, and mean disease duration was 7.2 ± 6.0 years. The prevalence of sarcopenia was 10 (15.4%) in diabetic patients and 5 (7.7%) in controls while the prevalence of presarcopenia was 7 (10.8%) in diabetic patients and 3 (4.6%) in controls (p-value = 0.133).ConclusionsPatients with type 2 diabetes mellitus had a higher prevalence of sarcopenia compared with healthy controls although statistically was not significant.     

Prevalence of urinary incontinence in males with type 2 diabetes mellitus

AimTo find the prevalence of Urinary Incontinence (UI) in males with Type 2 Diabetes Mellitus (T2DM) in Belagavi city and also to understand the severity of UI and the impact of variables like age, duration of diabetes, BMI (Body mass index), waist circumference, glycemic control (fasting blood glucose), and medications on the prevalence of UI in males with T2DM.MethodologyThis was a cross-sectional, observational study conducted in a tertiary hospital and medical research centre of Karnataka, India in which males aged 35 years or more and suffering with T2DM for at-least 10years were enrolled. UI was assessed using International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF).ResultsOut of 123 male subjects having T2DM screened for the prevalence of UI, 19 subjects were diagnosed to be having UI as per ICIQ-SF questionnaire, accounting to 15.4% of the total sample. The mean ICIQ score of the 19 subjects having UI was 9.2 ± 1.54 showing that the mean severity of UI was moderate in nature. Study also found that the duration of diabetes was significantly high (mean = 18 ± 4.6 years) and glycemic control was significantly poor (Mean FBS = 210 ± 64.21 mg/dL) in subjects with UI than in subjects without UI.ConclusionsPrevalence of UI among adult patients with T2DM was 15.4% and is of moderate severity, as assessed by ICIQ-SF. Long duration of Diabetes and poor glycemic control could possibly increase the risk of UI among T2DM patients.     

Prevalence of hypogonadism in patients with type 2 diabetes mellitus among the Indian population

ObjectivesTo determine the prevalence of hypogonadism among Indian men with and without type 2 diabetes mellitus (T2DM) and evaluate its association with various metabolic parameters.MethodsOne hundred fifty consecutive men with T2DM, aged 25–70 years, and one hundred age-matched healthy men without diabetes were included. The free testosterone (FT) level was calculated using the total testosterone (TT), sex hormone-binding globulin (SHBG), and albumin levels in serum. Patients with a calculated FT level <6.35 ng/dL and a positive response on the androgen deficiency in aging male questionnaire (ADAM) were diagnosed with hypogonadism.ResultsThe prevalence of hypogonadism was 17.3% and 10% in men with and without T2DM, respectively. The body mass index (BMI) and the mean levels of follicle-stimulating hormone (FSH), TT, SHBG, Triglycerides (TG), and FT were significantly different between the groups. The mean BMI and TG levels were significantly higher in patients with T2DM than in those without. Both groups showed a significant negative correlation between the BMI and SHBG level.ConclusionThe hypogonadism prevalence was higher in patients with T2DM than in those without, although the difference did not reach statistical significance.     

住院2型糖尿病患者合并尿路感染危险因素分析

目的：分析住院2型糖尿病患者尿路感染的患病情况及其临床特点,并探讨2型糖尿病患者合并尿路感染的危险因素。方法回顾性地分析香港大学深圳医院2013年10月至2014年9月内分泌与代谢科住院的2型糖尿病患者共249例,收集相应临床资料,比较尿路感染组与非感染组患者年龄、性别、体质量指数、糖尿病病程、糖化血红蛋白（HbA1c）、估算肾小球滤过率（eGFR）、肌酐、尿微量白蛋白/肌酐（ACR）、24h尿微量白蛋白定量、尿糖等指标的异同,分析2型糖尿病患者合并尿路感染的危险因素。结果住院2型糖尿病患者合并尿路感染的患病率为16.1%;年龄、性别、eGFR、ACR、24h尿微量白蛋白定量、肌酐在两组之间差异具有统计学意义（P＜0.05）,女性、年龄越大、肾功能越差、尿微量白蛋白越多的患者越易合并尿路感染。而尿糖、糖尿病病程、HbA1c、体质量指数在各组之间差异无统计学意义。logistic回归分析显示性别、肌酐是尿路感染的独立危险因素。结论2型糖尿病患者合并尿路感染与性别、肌酐相关,女性、肾功能不良的患者是高危人群。     

Relationship of residual beta-cell function, metabolic control and chronic complications in type 2 diabetes mellitus

As the relationships between C-peptide levels and metabolic control and chronic complications are poorly known in type 2 diabetes, due to the slow decline of beta-cell function, we evaluated these associations in a cohort of type 2 diabetic patients. After excluding insulin-trated subjects, 1533 patients were divided according to their C-peptide fasting levels in quartiles. Patients within the lowest C-peptide quartile showed significantly higher duration of diabetes, prevalence of retinopathy and values of HDL-cholesterol, albumin excretion rate and HbA1c, while BMI, diastolic blood pressure, percentages of hypertension and metabolic syndrome, and values of triglycerides and uric acid were significantly higher in the highest C-peptide quartile. The associations between C-peptide and duration of diabetes, AER, HbA1c, retinopathy and the components of the metabolic syndrome remained significant, after multiple adjustments. In conclusion, these data support the hypothesis that a reduced insulin secretion is associated with a longer duration of diabetes and a greater prevalence of microvascular complications, while higher insulin levels are associated with the components of the metabolic syndrome. Received: 21 August 2000 / Accepted in revised form: 5 December 2000     

Lipids,lipoproteins and apolipoproteins in type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus

Summary Total plasma cholesterol, triglycerides, VLDL-C, VLDL-TG, HDL-C and the apoproteins A-I, A-II, B and D were measured in 111 male non-obese diabetic patients and in 90 male control subjects of similar age and body weight distribution. Forty-eight patients had Type 1 (insulin-dependent diabetes) and 63 had Type 2 (non-insulin-dependent diabetes); all were in stable metabolic control while following an appropriate diet and therapy with insulin or oral hypoglycemic agents. HDL-C, apoA-I, apoB and the apoA-I/apoA-II ratio were significantly increased in the Type 1 patients, whereas the VLDL-C/VLDL-TG and LDL-C/apoB ratios were decreased significantly. Type 2 diabetics showed low HDL-C and low apoA-I/apoA-II ratio, while the values of apoA-I, A-II, D and the VLDL-C/VLDL-TG ratio were significantly higher than in controls. Type 1 diabetics in ‘fair’ metabolic control presented higher values of TG, VLDL-C, VLDL-TG and apoB than patients in ‘good’ control: lower values of apoA-I and of the ratios apoA-I/apoA-II, apoA-I/apoB and LDL-C/apoB were recorded in the same subgroup. In Type 2 diabetics no significant differences were observed according to metabolic control, with the exception of a higher apo-D value in subjects in ‘fair’ control. The data obtained support the view that good metabolic control may be important for the prevention of a relevant derangement of lipoprotein components, particularly in Type 1 patients. Partially supported by grant No. 83.02521.56 fromConsiglio Nazionale delle Ricerche (CNR), Roma, Italy (Progetto Finalizzato di Medicina Preventiva e Riabilitativa).     

Pancreatic autoantibodies in Italian patients with newly diagnosed type 1 diabetes mellitus over the age of 20 years

Abstract The aim was to estimate the prevalence of the serological markers of pancreatic autoimmunity in a cohort of Italian patients with type 1 diabetes mellitus occurring after 20 years of age in order to determine the prevalence of autoimmune diabetes and the most sensitive autoantibody combination to be employed for the diagnosis. We investigated 57 patients (31 males and 26 females) at clinical diagnosis of type 1 diabetes. 35 patients were 21–40 years and 22 were 41–72 years of age. Autoantibodies to islet-cells (ICA) were detected by indirect immunofluorescence, while those against glutamic acid decarboxylase (GADA), tyrosine-phosphatase (IA2A) and insulin (IAA) were detected by radiobinding assays. A positive test for at least one of the pancreatic autoantibodies was found in 45 of the 57 patients (78.9%). Coupling two antibody tests, GADA and/or IAA were found in 73.7%, ICA and/or GADA in 71.9%, while GADA and/or IA2A were found in 70.2% of the patients. The most frequently positive test was for GADA (66.7%). In general, the frequency of diabetes-related antibodies was higher in the 21–40-year-old group compared to the 41–72-year-old group and in females than males. Based on the detection of pancreatic autoantibodies determination, the great majority of the adult patients with recent onset type 1 diabetes were found to be autoimmune in nature. The best cost/benefit combination is provided by coupling the detection of GADA and ICA.     

Retinopathy in latent autoimmune diabetes of adults: the Fremantle Diabetes Study.

AIMS: To determine the prevalence of retinopathy and its associations in patients diagnosed clinically with Type 2 diabetes and serum antibodies to glutamic acid decarboxylase (GADA) from a community-based sample. METHODS: In a case-control design, 24 GADA-positive Type 2 patients from the Fremantle Diabetes Study (FDS) cohort were recruited and matched as closely as possible for age, sex and diabetes duration with 72 GADA-negative Type 2 patients from the FDS. Each patient had a detailed clinical and biochemical assessment including slit lamp biomicroscopy and colour fundus photography with Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) grading. RESULTS: The GADA-positive patients had a significantly higher HbA1c (median (interquartile range); 8.4 (7.3, 9.6)%) than those who were GADA-negative (7.2 (6.5, 8.1)%: P = 0.002). The overall prevalence of retinopathy amongst the 96 subjects was 26.0%. The majority (92%) of the retinopathy detected was mild and non-proliferative. GADA-positive patients had double the retinopathy prevalence of the GADA-negative group (41.7% vs. 20.8%; P = 0.044). In a logistic regression model, diabetes duration, HbA1c, systolic blood pressure and current smoking were each significantly and independently predictive of retinopathy (P < 0.025), but GADA status was not. CONCLUSIONS: These data show that GADA-positive patients have an increased prevalence of retinopathy compared with GADA-negative controls with Type 2 diabetes from an urban Australian community. This increased prevalence is due mainly to relatively poor glycaemic control in the GADA-positive group.     

Fasting plasma C-peptide,glucagon stimulated plasma C-peptide,and urinary C-peptide in relation to clinical type of diabetes

Summary Many patients with Type 2 (non-insulin-dependent) diabetes mellitus are treated with insulin in order to control hyperglycaemia. We studied fasting plasma C-peptide, glucagon stimulated plasma C-peptide, and 24 h urinary C-peptide in relation to clinical type of diabetes in 132 insulin treated diabetic subjects. Patients were classified clinically as Type 1 (insulin-dependent) diabetic subjects in the presence of at least two of the following criteria: 1) significant ketonuria, 2) insulin treatment started within one year after diagnosis, 3) age of diagnosis 40 years, and 4) weight below 110% of ideal weight of the same age and sex. Eighty patients were classified as Type 1 and 52 as Type 2 diabetic subjects. A second classification of patients into 6 C-peptide classes was then performed. Class I consisted of patients without islet B-cell function. Class II-VI had preserved islet B-cell function and were separated according to the 20%, 40%, 60% and 80% C-peptide percentiles. The two classifications of patients were compared by calculating the prevalence of clinical Type 1 and Type 2 diabetes in each of the C-peptide classes. This analysis showed that patients with a fasting plasma C-peptide value <0.20 nmol/l, a glucagon stimulated plasma C-peptide value <0.32 nmol/l, and a urinary C-peptide value <3.1 nmol/l, or <0.54 nmol/mmol creatinine/24 h, or <5.4 nmol/24 h mainly were Type 1 diabetic patients; while patients with C-peptide levels above these values mainly were Type 2. At these limits the percentage, predictive value of positive tests as indicators of Type 2 diabetes were as follows: fasting C-peptide 83%, stimulated C-peptide 86%, and urinary C-peptide expressed as nmol/l 76%, as nmol/mmol creatinine/24 h 79%, and as nmol/24 h 78%. Similarly, the percentage predictive value of negative tests as indicators of Type 1 diabetes were as follows: fasting C-peptide 86%, stimulated C-peptide 88%, and urinary C-peptide expressed as nmol/l 79%, as nmol· mmol creatinine·24 h 81%, and as nmol/24 h 80%. If patients without detectable C-peptide were excluded, the predictive value of negative tests were as follows: fasting C-peptide 81%, stimulated C-peptide 88%, urinary C-peptide expressed as nmol/l 61%, as nmol/mmol creatinine/24 h 69%, and as nmol/24 h 64%. In conclusion, post glucagon C-peptide gives a good distinction between Type 1 and Type 2 diabetes mellitus in insulin treated diabetes while 24 h urinary C-peptide gives a less sensitive distinction between the clinical types of diabetes.     

Frequency of type I and II diabetes in newly diagnosed diabetic patients: Measuring C-Peptide level

AimsDiabetes mellitus is a metabolic disease that manifested as hyperglycemia due to the defect in secretion or function of insulin. This study aimed was to survey about frequency type I and II diabetes in newly diagnosed diabetic patients base on c-peptide and anti-glutamate acid decarboxylase (GAD) tests.Materials & methodsThis study was conducted as a prospective study on 70 diabetic patients aged 15–45 years old who referred to diabetes clinics in Ahvaz city during 2012–2014 and their diabetes was diagnosed for the first time, but their type of diabetes was not clinically definitive. Patients with anti-GAD positive and fasting C-peptide level of less than 0.65 were diagnosed as type I diabetes. Patients with anti-GAD negative fasting C-peptide level of greater than or equal to 0.65 were considered as type II diabetes.ResultsEighty two patients (49 males and 33 females) with a mean age of 21.64 ± 4.36 years (range 15–34) and a mean BMI of 22.05 ± 4.41 kg/m² (range 14–18) were studied. Twenty three patients (28.5%) had type I diabetes and 59 patients (71.95%) had type II diabetes. In patients with type I diabetes, the mean BMI was 24.86 ± 2.36 kg/m² and the number of patients with family history (56.22%) was higher. In type II diabetic patients, the number of women (62.71%) was higher than that of men.ConclusionAnti-GAD test can be used as a predictive test for early diagnosis of disease and screening of people with a diagnosis of diabetes based on the type of diabetes.