Low-Grade Inflammatory Markers May Help Differentiate Diabetes Diagnoses in Adults

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Latent autoimmune diabetes in adults vs classic adult-onset type 1 diabetes was independently related to soluble tumor necrosis factor-a receptor 2 and high-sensitivity C-reactive protein levels.
Latent autoimmune diabetes in adults vs classic adult-onset type 1 diabetes was independently related to soluble tumor necrosis factor-a receptor 2 and high-sensitivity C-reactive protein levels.

Serum concentrations of adiposity-related low-grade inflammatory mediators may help to differentiate the diagnosis of latent autoimmune diabetes in adults (LADA) from that of classic adult-onset type 1 diabetes and type 2 diabetes, according to a cross-sectional study published in Diabetes Care.1

The role of obesity and the degree of insulin resistance in LADA is controversial, yet patients with LADA in the Spanish population have distinctive adiposity and metabolic profile characteristics compared with patients with classic adult-onset type 1 diabetes and type 2 diabetes.2,3

Researchers in Spain performed analyses on a cohort of 75 patients with LADA, 67 patients with classic adult-onset type 1 diabetes, and 390 patients with type 2 diabetes, and found that innate immunity-related inflammatory markers were associated with elements of metabolic syndrome.1

For example, multiple logistic models indicated that increased soluble tumor necrosis factor-α receptor 2 (sTNFRII) levels were a predictor for a higher risk for LADA than for classic adult-onset type 1 diabetes. In addition, the leukocyte count and sTNFRII values gradually increased from classic adult-onset type 1 diabetes to LADA and from LADA to type 2 diabetes, whereas adiponectin followed the opposite direction.

Moreover, the levels of high-sensitivity C-reactive protein among patients with LADA were lower than in patients with classic adult-onset type 1 diabetes, and much lower than in patients with type 2 diabetes. However, low-grade inflammatory markers independently contributing to the risk of a specific diabetes type were not ideal as single predictors for differentiating patients with or without LADA.

"If the performance of these models is externally validated in independent populations, they may have potential clinical utility to identify individuals with higher odds of having LADA than classic adult-onset type 1 diabetes or type 2 diabetes, along with islet autoantibody positivity," recommended the authors.1


References

  1. Castelblanco E, Hernández M, Castelblanco A, et al. Low-grade inflammatory marker profile may help to differentiate patients with LADA, classic adult-onset type 1 and type 2 diabetes. Diabetes Care. 2018;41:dc171662.
  2. Naik RG, Brooks-Worrell BM, Palmer JP. Latent autoimmune diabetes in adults. J Clin Endocrinol Metab. 2009;94:4635-4644.
  3. Mollo A, Hernandez M, Marsal JR, et al; Action LADA 8. Latent autoimmune diabetes in adults is perched between type 1 and type 2: evidence from adults in one region of Spain [published correction appears in Diabetes Metab Res Rev. 2013;29:693]. Diabetes Metab Res Rev. 2013;29:446-451.
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