Chronic complications in patients with slowly progressing autoimmune type 1 diabetes (LADA)

OBJECTIVE - To study the prevalence of chronic diabetic complications in pa tients with the slowly progressing autoimmune form of type 1 diabetes, also referred to as latent autoimmune diabetes in adults (LADA). RESEARCH DESIGN AND METHODS - We evaluated factors associated with chronic diabetic complications in 59 patients with GAD antibodies (GADAs) and age a t onset of diabetes >35 years and in 59 GADA negative type 2 diabetic patie nts. The prevalence of chronic complications was further compared with the prevalence in 111 type 1 diabetic patients. RESULTS - The LADA patients had lower BMI (P = 0.04), waist-to-hip ratio (P = 0.02 for men and P = 0.03 for women), and fasting C-peptide concentratio ns (P < 0.001) higher HDL2 concentrations (P = 0.04), and less hypertension (58 vs. 75%, P = 0.05) than the type 2 diabetic patients. These difference s were even more marked in patients with short disease duration. The preval ence of retinopathy (51 vs. 56%), neuropathy (29 vs. 27%), and microalbumin uria (27 vs. 29%) did not differ between the groups. The type 1 diabetic pa tients had lower prevalence of neuropathy (13%, P = 0.02) and higher preval ence of retinopathy (76%, P = 0.002) compared with the other groups. Neithe r the prevalence of coronary heart disease (CHD) (56 vs. 58%) nor cardiovas cular mortality (7.4 vs. 12.4%, P = 0.2) significantly differed between the LADA and type 2 diabetic patients. In a multiple logistic regression analy sis, glycemic control was associated with CHD (P = 0.02) in the LADA group but not in the type 2 diabetic group. CONCLUSIONS - Glycemic control is a stronger risk factor for cardiovascular disease in LADA patients than in patients with type 2 diabetes. This could be related to the lower prevalence of the metabolic syndrome seen in the f ormer.