Background: Measuring fasting C-peptide (FCP) and antibodies against Glutamic acid decarboxylase (GADA) and Islet cell antibodies (ICA) are not so commonly explored in children and young adults. Objectives: To assess the levels of FCP, GADA and ICA in subjects below the age of 25 years with DM and compare their levels to differentiate between Autoimmune and Non-Autoimmune Type 1 DM. Methodology: Blood samples of 93 subjects diagnosed with DM, reporting to the tertiary care hospital, were analysed for ICA, GADA and FCP. Receiver operating characteristics (ROC) curves were analysed to check the ability of autoimmune markers, BMI and C-peptide to differentiate between Autoimmune (Ai) and Non-Autoimmune (NonAi) diabetes. Results: 30/93 (32.2%) were positive for anti-GAD ab and/or ICA and categorised as Autoimmune (Ai), the most common antibody being, anti-GAD ab (80%) in them. The level of FCP among Ai compared to NonAi, was significantly low (p < 0.001). The combined effect of Age and BMI on the level of FCP was lesser in autoimmune diabetes. Receiver Operating Characteristic Curve ROC analysis demonstrated the advantage of raised GAD ab (>20.75 nmol/l) as a very dependable test for diagnosing Ai, Type 1 DM, in children and young adults. Its sensitivity and specificity are in the range of 86.2% and 96.8% respectively. Low level of C-peptide (<0.36 nmol/l) is a fair indicator for diagnosing Ai diabetes in the same population unlike BMI. Conclusion: This study revealed predominant positivity for anti-GAD ab (80%) among Ai+ patients. ROC analysis shows GADA above 20.75 nmol/l and Fasting C-peptide < 0.36 nmol/l as a good indicator for diagnosing Ai in children and young adults.
References
[1]
Powers, A.C. (2015) Diabetes Mellitus: Diagnosis, Classification and Pathophysiology. In: Kasper, D.L., Fauci, A.S., Hauser, S.L., Longo, D.L., Larry Jameson, J. and Loscalzo, J., Eds., Harrison’s Principles of Internal Medicine, Vol. 2, 19th Edition, McGraw-Hill, New York, 2399-2407.
[2]
Anjana, R.M., Pradeepa, R., Deepa, M., Datta, M., Sudha, V., Unnikrishnan, R., et al. (2011) Prevalence of Diabetes and Prediabetes (Impaired Fasting Glucose and/or Impaired Glucose Tolerance) in Urban and Rural India: Phase I Results of the Indian Council of Medical Research–India Diabetes (ICMR–INDIAB) Study. Diabetologia, 54, 3022-3027. https://doi.org/10.1007/s00125-011-2291-5
[3]
Das, A.K. (2015) Type 1 Diabetes in India: Overall Insights. Indian Journal of Endocrinology and Metabolism, 19, S31-S33. https://doi.org/10.4103/2230-8210.155372
[4]
Praveen, P.A., Madhu, V., Mohan, V., Das, S., Kakati, S., et al. (2016) Registry of Youth Onset Diabetes in India (YDR): Rationale, Recruitment, and Current Status. Journal of Diabetes Science and Technology, 10, 1034-1041. https://doi.org/10.1177/1932296816645121
[5]
Powers, A.C. (2015) Diabetes Mellitus: Complications. In: Kasper, D.L., Fauci, A.S., Hauser, S.L., Longo, D.L., Larry Jameson, J. and Loscalzo, J., Eds., Harrison’s Principles of Internal Medicine, Vol. 2, 19th Edition, McGraw-Hill, New York, 2422-2430.
[6]
Leighton, E., Sainsbury, C.A.R. and Jones, G.C. (2017) A Practical Review of Peptide Testing in Diabetes. Diabetes Therapy, 8, 475-487. https://doi.org/10.1007/s13300-017-0265-4
[7]
Sacks, D.B., Arnold, M., Bakris, G.L., Bruns, D.E., Horvath, A.R., Kirkman, M.S., et al. (2011) Position Statement Executive Summary: Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care, 34, 1419-1423. https://doi.org/10.2337/dc11-9997
[8]
Arnqvist, H.J., Littorin, B., Nystrom, L., Schersten, B., Ostman, J., Blohme, G., Lithner, F. and Wibell, L. (1993) Difficulties in Classifying Diabetes at Presentation in the Young Adult. Diabetic Medicine, 10, 606-613.
[9]
Chan, J.C. and Ng, M.C. (2003) Lessons Learned from Young-Onset Diabetes in China. Current Diabetes Reports, 3, Article No. 101. https://doi.org/10.1007/s11892-003-0032-y
[10]
Thunande, M., Carina, T., Petersson, C., Ossiansson, B., Fornander, J., Landin-Olsson, M. (2012) Levels of C-Peptide, Body Mass Index and Age, and Their Usefulness in Classification of Diabetes in Relation to Autoimmunity, in Adults with Newly Diagnosed Diabetes in Kronoberg, Sweden. European Journal of Endocrinology, 166, 1021-1029. https://doi.org/10.1530/EJE-11-0797
[11]
Marchetti, P., Lupi, R., Del Guerra, S., Bugliani, M., D’Aleo, V., Occhipinti, M., Boggi, U., Marselli, L. and Masini, M. (2009) Goals of Treatment for Type 2 Diabetes: Beta-Cell Preservation for Glycemic Control. Diabetes Care, 32, S178-S183. https://doi.org/10.2337/dc09-S306
[12]
Khadilkar, V., Yadav, S., Agrawal, K.K., Tamboli, S., Banerjee, M., Cherian, A., et al. (2015) Revised IAP Growth Charts for Height, Weight and Body Mass Index for 5- to 18-Year-Old Indian Children. Indian Pediatrics, 52, 47-55. https://doi.org/10.1007/s13312-015-0566-5
[13]
CDC (Centers for Disease Control and Prevention) (n.d.) Using the BMI-for-Age Growth Charts. https://www.cdc.gov/nccdphp/dnpa/growthcharts/training/modules/module1/text/module1print.pdf
[14]
Sanyal, D., Batabyal, S.K., Maity, S., Chatterjee, S. (2019) Changing Autoimmunity in Indian Type 1 Diabetes Children. Clinical Diabetology, 8, 116-120. https://doi.org/10.5603/DK.2019.0005
[15]
Sabbah, E., Savola, K., Kulmala, P., Veijola, R., Vähäsalo, P., Karjalainen, J., et al. (1999) Diabetes-Associated Autoantibodies in Relation to Clinical Characteristics and Natural Course in Children with Newly Diagnosed Type 1 Diabetes. The Childhood Diabetes in Finland Study Group. Journal of Clinical Endocrinology & Metabolism, 84, 1534-1539. https://doi.org/10.1210/jcem.84.5.5669
[16]
Das, S., Bhoi, S.K., Baliarsinha, A.K. and Baig, M.M.A. (2007) Autoimmunity, Insulin Resistance and Betacell Function in Subjects with Low Bodyweight Type 2 Diabetes Mellitus. Metabolic Syndrome and Related Disorders, 5, 136-141. https://doi.org/10.1089/met.2006.0024
[17]
Krischer, J.P., Liu, K., Vehik, K., Akolkar, B., Hagopian, W.A., Rewers, M.J., et al. (2019) Predicting Islet Cell Autoimmunity and Type 1 Diabetes: An 8-Year TEDDY Study Progress Report. Diabetes Care, 42, 1051-1060. https://doi.org/10.2337/dc18-2282
