Frequency, clinical features, inflammatory cytokines and genetic background of latent autoimmune diabetes in youth in youth-onset type 2 diabetes: Results from a nationwide, multicentre, clinic-based, cross-sectional study (LADA China).

AIM: To investigate the frequency, clinical phenotype, inflammatory cytokine levels and genetics of glutamic acid decarboxylase autoantibody (GADA)-positive phenotypic youth-onset type 2 diabetes. MATERIALS AND METHODS: This nationwide, multicentre, cross-sectional study included 5324 newly diagnosed subjects with phenotypic type 2 diabetes aged 15 years or older enrolled in the LADA China study. GADA was screened in 248 subjects with youth-onset type 2 diabetes aged 15-29 years. Subjects who presented as GADA-positive were defined as having latent autoimmune diabetes in youth (LADY). We added subjects with LADY, type 1 diabetes, type 2 diabetes and controls from the Diabetes Center of Central South University, and measured serum concentrations of interleukin-6, lipocalin 2, high-sensitivity C-reactive protein, adiponectin and human leukocyte antigen (HLA) genotyping in subjects with LADY, age- and sex-matched GADA-negative type 2 diabetes, type 1 diabetes and controls. RESULTS: Twenty-nine of the 248 subjects (11.7%) were GADA positive. Compared with subjects with type 2 diabetes, subjects with LADY were less probable to have metabolic syndrome (27.6% vs. 59.4%; p = .001). The fasting C-peptide levels tended to be lower in subjects with LADY than in subjects with type 2 diabetes, but the difference was not statistically significant (LADY vs. type 2 diabetes: 0.21 [0.17-0.64] vs. 0.47 [0.29-0.77] nmol/L; p = .11). The cytokine levels of subjects with LADY were indistinguishable from subjects with type 1 diabetes, but subjects with LADY presented increased adiponectin levels compared with subjects with type 2 diabetes after adjusting for age, sex and body mass index (7.19 [4.05-11.66] vs. 3.42 [2.35-5.74] µg/mL; p < .05). The frequency of total susceptible HLA genotypes (DR3/3, -3/9 and -9/9) in subjects with LADY and type 1 diabetes were similarly higher than controls (LADY and type 1 diabetes vs. controls: 21.4% and 30.8% vs. 2.6%, respectively; p < .001). CONCLUSIONS: A high GADA positivity was observed in youth-onset type 2 diabetes subjects in China. As subjects with LADY had an increased susceptible HLA genetic load and different cytokine levels compared with subjects with type 2 diabetes, differentiating LADY from phenotypic type 2 diabetes subjects is important.

Prevalence of metabolic syndrome (MetS) in Chinese subjects gradually increased with impaired glucose homeostasis: a multicenter, clinical based, cross-sectional study.

BACKGROUND: Metabolic Syndrome (MetS) is a high risk factor for Cardiovascular Diseases (CVD). We estimated to investigate how MetS prevalence by glucose homeostasis varies across different age and gender groups. METHODS: We studied 9257 Chinese subjects over the age of 15 years in two cross-sectional surveys in 2006. With oral glucose tolerance test (OGTT) test, 2341 subjects were normal glucose tolerance (NGT), and 5448 were diagnosed as having type 2 diabetes (T2D). All other 1468 subjects were considered to be impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) subjects. Diabetes was diagnosis by WHO99 criteria. We used modified NCEP-III criteria for the diagnosis of MetS. RESULTS: The prevalences of MetS in the male NGT, IFG/IGT and T2D groups were 25.9% (404/1559), 65.6% (769/1172), and 73.5% (2483/3376), respectively. The prevalences of MetS in the female NGT, IFG/IGT and T2D groups were 13.4% (105/782), 51.0% (151/296), and 75.4% (1563/2072), respectively. The prevalence of MetS in the male IFG/IGT group gradually decreased from 73.26% to 41.08% in subjects over the age of 30 years. The prevalence of MetS in the female IFG/IGT group gradually increased from 30% to 75% with aging. CONCLUSIONS: The prevalence of MetS in subjects with different glucose tolerances in China was high and gradually increased with impaired glucose homeostasis both in males and females.

Angiopoietin-like protein 3 and adiponectin levels in patients with metabolic syndrome.

OBJECTIVE: To investigate the changes of serum angiopoietin-like protein 3 (Angptl3) and adiponectin levels in patients with metabolic syndrome (MS) in order to understand their association with the MS. METHODS: Serum Angptl3 and adiponectin levels were measured by sandwich ELISA in a group of 111 patients with MS and 152 normal controls. RESULTS: Serum adiponectin was lower in the MS patients than in the control subjects [4.22(1.01-23.29) microg/mL vs. 5.41(0.97-22.27) microg/mL, P<0.05]. With regard to serum Angptl3, there was no significant difference between the 2 groups(P>0.05). Serum adiponectin was correlated to Angptl3 and high density lipoprotein-cholesterol (HDL-C)(P<0.001) and negatively correlated to body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), triglyceride (TG), fasting plasma glucose (FBG), fasting insulin (FINS) and homeostatic model assessment method-insulin resistance (HOMA-IR) (P<0.001). Serum Angptl3 was positively correlated with adiponectin (P<0.001). Serum adiponectin was found to be independently positive determinant for Angptl3 concentrations (b'=0.256, P<0.001). Adiponectin was inversely correlated with TG and HOMA-IR (b'=-0.234, -0.145, P<0.001). CONCLUSION: Adiponectin is decreased in MS patients and may be correlated to Angptl3.

[Immunological features of fulminant type 1 diabetes].

OBJECTIVE: To investigate the immunological features of fulminant type 1 diabetes. METHODS: Twenty patients with fulminant type 1 diabetes (F1D) were recruited based upon the criteria proposed by Hanafusa, and 40 patients with classical type 1 diabetes were matched with age, gender and duration for comparison. GADA, IA2A and ZnT8A were determined with radioligand assay, and GAD-reactive T cells were measured by enzyme-linked immunospot (ELISPOT) assay. The HLA-DQ were analyzed by sequence-based genotyping (SBT). RESULTS: Eight of 20 patients with F1D were antibody-positive, including 7 GADA positive, 4 ZnT8A positive, and 3 both GADA and ZnT8A positive. The index of 3 GADA positive patients were less than 0.4 at first visit, two turned to be negative by two or three years. While the GADA index of the patient was 0.343 at onset and increased to 1.467 three years later. Among subjects with F1D (3/6) and classical type 1 diabetes (3/6), were recorded significant GAD-stimulated responses by ELISPOT assay. The frequencies of HLA-DQA1*0102-DQB1*0601 and DQA1*03-DQB1*0401 were significantly higher in F1D than those in classical type 1 diabetes (P = 0.005, P = 0.035, respectively). CONCLUSION: Humoral and cellular immunoreactivity and susceptible HLA-DQ genotype existed in part of F1D patients, indicating autoimmunity may involve in the pathogenesis of F1D.

[Non-alcoholic fatty liver, high sensitivity C reactive protein and insulin resistance].

OBJECTIVE: To explore the relationship among non-acoholic fatty liver disease (NAFLD), high sensitivity reactive C protein (hsCRP) and insulin resistance. METHODS: Workers of an enterprise in Changsha for health examination in Second Xiangya Hospital from October to December, 2006, NAFLD group (243 patients) and a control group without fatty liver disease (361 patients) were randomly drawn. Questionnaire, physical examination, fasting plasma glucose, serum lipid-profile, alanine aminotransferase (ALT),blood uric acid, and abdominal ultrasonographic examination were undertaken in the 2 groups. RESULTS: The moderate NAFLD group had significantly higher hsCRP concentration and homeostasis model assessment of insulin resistance (HOMA-IR) as compared with the mild NAFLD group (P<0.01). The patients with insulin resistance had significantly higher hsCRP concentration and ALT level compared with NAFLD patients without insulin resistance (P<0.05). The NAFLD patients were divided into 2 groups (low and high) according to the hsCRP concentration (<1 mg/L or > or = 1 mg/L). Compared with the low concentration group, the odds ratio of the high concentration group for prevalence of NAFLD was 5.937(P<0.001). Multi-factor logistic regression analysis demonstrated that NAFLD was independently correlated with hsCRP or HOMA-IR after adjustment for sex, age and metabolic components (OR=2.044, 7.896,P<0.01). CONCLUSION: NAFLD is closely correlated with hsCRP and HOMA-IR. Insulin resistance and elevated hsCRP concentration are the independent risk factors for the presence of NAFLD.