Differential diagnosis of diabetes in young and prevalence of LADA and LADY in young persons attending tertiary diabetes institute in Bengaluru, India

Dr R.Anil kumar, Professor and HOD Diabetes and endocrinology, Karnataka institute of endocrinology and research, Bangalore-560069. 3370 young diabetes persons were clinically screened 2414 (71.6%) were type 2 diabetes, 843 (25%) were type 1 diabetes and 3.4% constituted LADA, MODY and FCPD. GAD and IA2 antibodies were measured in 381 persons, statistical analysis was done and 2.1% were LADA and 5.1% belong to LADY.

Materials and methods-381 patients were randomly selected from patients with age of onset of diabetes less than 35 years attending the outpatient department of Karnataka institute of endocrinology and research Bangalore over a period of 2 years. A fasting and post prandial blood sample was taken for estimation of plasma glucose by hexokinase method. HBA1C was measured by the high-performance liquid chromatography method using the Bio-rad Variant 2 turbo analyzer. Diagnosis of diabetes was made by using criteria of fasting plasma glucose ≥126 mg/dl and HBA1c ≥6.5%. GAD 65 and IA 2 antibodies were estimated using ELISA methods.

Results- Age of onset of all diabetes subjects is less than 35 years. 34.6% and 60.6% of the subjects were in the age group of 20 to 30 and 31-40 years, 72.4% were males. Newly diagnosed subjects were 17.3%, duration of diabetes 1 to 5 years in 63.8% and 6 to 10 years in 14.2% of type 2 diabetes subjects.  BMI was 18.5 to 24.9 in 54.3% and 25 to 29.9 in 38.1% of subjects. Antibody positivity was detected in 29 (7.61%) of 381 subjects studied. GAD antibody positive in 22 (6.04%), IA 2 antibody positive in 5(1.3%) and 2(.52%) were positive for both antibodies in diabetes subjects. 2.1% were LADA and 5.1% belong to LADY.

Conclusions-Antibody positivity was detected in 29 (7.61%) of 381 subjects studied. 2.1% patients were LADA and 5.1% were LADY. So if we test GAD antibodies in Indian diabetes subjects we can detect many LADA and LADY patients. Immunomodulator therapy in antibody positive type 2 diabetes subjects may help to reduce beta call destruction.

Keywords: LADY, LADA, GAD antibodies, IA2 antibodies, C-Peptide.

LADA-Latent autoimmune diabetes in adults and LADY-Latent autoimmune diabetes in young.

Dr R.Anil kumar is working as professor and head of department of diabetes and endocrinology at Karnataka institute of endocrinology and research Bangalore. He has completed MBBS in 1987 and MD in 1999. He has WHO fellowship in diabetology, Fellowship of royal college of physicians, Edinburgh, Fellowship of Indian college of physicians and fellowship of research society of diabetes in India. He has published more than 40 research articles. He was Speaker in national and international conferences. He had delivered orations state and national conferences. He has treated more than 1 lakh diabetes patients.