Differential Associations of GAD Antibodies (GADA) and C-Peptide With Insulin Initiation, Glycemic Responses, and Severe Hypoglycemia in Patients Diagnosed With Type 2 Diabetes
Authors' conclusion
There is considerable heterogeneity in autoimmunity and β-cell dysfunction in T2D with GADA+ and high CP associated with early insulin initiation, while GADA+ and low CP, increased the risk of severe hypoglycemia. Extended phenotyping is warranted to increase the precision of classification and treatment in T2D.
Study context
- Population
- Chinese patients with T2D (47.6% men; mean ± SD age 56.5 ± 13.9 years; median diabetes duration 6 [IQR 1, 12] years), enrolled consecutively 1996–2012, observed until 2019
- Participants
- 5,230 patients
- Exposure
- GADA+ vs GADA−; low C-peptide vs high C-peptide
- GADA+n = 257
- Low-CPn = 1,494
- Outcome
- Insulin initiation
Methodological detailsconsecutive enrolment, retrospective measurement of fasting C-peptide and GADA in stored serum
- Consecutive enrolment
- Retrospective measurement of fasting C-peptide and GADA in stored serum
Main finding
As reported in the abstract
Adjusted hazard ratio (95% CI)P value
GADA+vs GADA-
1.46(1.15–1.84)
P = 0.002Low-CPvs High-CP
0.88(0.77–1.00)
P = 0.051Observational data: associations, not effects.
Further findings
| Outcome | GADA+ | Low-CP |
|---|---|---|
| Baseline prevalence and overlap of low CP and GADA+ | 4.9% | 28.6% |
| GADA+ within group | — not stated in the abstract | 8.0% |
| Low CP within group | 46.3% | — not stated in the abstract |
— not stated in the abstract
HbA1c change after insulin initiation · months 6 and 12
- GADA+ plus low-CP group had the largest HbA1c decrements: at month 6
- −1.9%
- GADA+ plus low-CP at month 12
- −1.5%
- Other three groups
- −1%
Safety
Severe hypoglycemia
| aHR (95% CI) | P value | ||
|---|---|---|---|
| Low-CP | 1.29 (1.10–1.52) | P = 0.002 | |
| GADA+ | 1.38 (1.04–1.83) | P = 0.024 | |
| 0.512Adjusted hazard ratio (log scale) |
Original publication
Differential Associations of GAD Antibodies (GADA) and C-Peptide With Insulin Initiation, Glycemic Responses, and Severe Hypoglycemia in Patients Diagnosed With Type 2 Diabetes. Diabetes Care. Published 19 April 2023. doi:10.
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