Clinical Characteristics, Residual Beta-Cell Function and Pancreatic Auto-Antibodies in Thai people with Long-Standing Type 1 Diabetes Mellitus
Objectives. To describe the characteristics of long-standing T1DM in Thai patients and assess residual beta-cell function with status of pancreatic autoantibodies.
Methodology. This is a cross-sectional study of Thai subjects with T1DM and disease duration ≥25 years seen at the Theptarin Hospital. Random plasma C-peptide and pancreatic auto-antibodies (Anti-GAD, Anti-IA2, and Anti-ZnT8) were measured. Patients who developed complications were compared with those who remained free of complications.
Results. A total of 20 patients (males 65%, mean age 49.4±12.0 years, BMI 22.5±3.1 kg/m2, A1C 7.9±1.6%) with diabetes duration of 31.9±5.1 years were studied. Half of the participants remained free from any diabetic complications while the proportions reporting retinopathy, nephropathy, and neuropathy were 40%, 30%, and 15%, respectively. HDL cholesterol was significantly higher and triglyceride concentration significantly lower in patients who were free from diabetic nephropathy but not in those who were free from other complications. The prevalence rates of anti-GAD, anti-IA2, and anti-ZnT8 were 65%, 20%, and 10%, respectively. None of the patients who tested negative for both anti-GAD and anti-IA2 was positive for anti-ZnT8. Residual beta-cell function based on detectable random plasma C-peptide (≥0.1 ng/mL) and MMTT was found in only 3 patients (15%). There was no relationship between residual beta-cell function and protective effects of diabetic complications.
Conclusion. Endogenous insulin secretion persists in some patients with long-standing T1DM and half of longstanding T1DM in Thai patients showed no diabetic complications. HDL cholesterol was significantly higher and triglyceride concentration significantly lower in patients who were free from diabetic nephropathy.
Keenan HA, Sun JK, Levine J, et al. Residual insulin production and pancreatic beta-cell turnover after 50 years of diabetes: Joslin Medalist Study. Diabetes. 2010; 59(11):2846-53. https://www.ncbi.nlm.nih.gov/pubmed/20699420. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963543. https://doi.org/10.2337/db10-0676.
Wang L, Lovejoy NF, Faustman DL. Persistence of prolonged C-peptide production in type 1 diabetes as measured with an ultrasensitive C-peptide assay. Diabetes Care. 2012;35(3):465-70. https://www.ncbi.nlm.nih.gov/pubmed/22355018.
Davis AK, DuBose SN, Haller MJ, et al. Prevalence of detectable C-Peptide according to age at diagnosis and duration of type 1 diabetes. Diabetes Care. 2015; 38(3):476-81. https://www.ncbi.nlm.nih.gov/pubmed/25519448. https://doi.org/10.2337/dc14-1952.
Liu W, Han X, Wang Y, et al. Characteristics and ongoing autoimmunity of patients with long-standing type 1 diabetes living in China. Diabetes Care. 2018;41(6):e97-8. PMID: 29615395. https://doi.org/10.2337/dc18-0046.
Jones AG, Hattersley AT. The clinical utility of C-peptide measurement in the care of patients with diabetes. Diabet Med. 2013;30(7):803–17. https://www.ncbi.nlm.nih.gov/pubmed/23413806. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748788. https://doi.org/10.1111/dme.12159.
Hanna SJ, Powell WE, Long AE, et al. Slow progressors to type 1 diabetes lose islet autoantibodies over time, have few islet antigen specific CD8+ T cells and exhibit a distinct CD95hi B cell phenotype. Diabetologia. 2020;63(6):1174-85. https://www.ncbi.nlm.nih.gov/pubmed/32157332.
Trisorus C, Aroonparkmongkol S, Kongmanas HB, Sahakitrungruang T. Prevalence of islet autoantibodies in Thai juvenile-onset type 1 diabetes. Pediatr Int. 2018;60(11):1002-7. https://doi.org/10.1111/ped.13687.
Bain SC, Gill DV, Dyer PH, et al. Characteristics of type 1 diabetes of over 50 years duration (the golden years cohort). Diabet Med. 2003;20(10):808-11. https://www.ncbi.nlm.nih.gov/pubmed/14510860. https://doi.org/10.1046/j.1464-5491.2003.01029.x.
Otani T, Kasahara T, Miura J, Uchigata Y, Babazono T. Clinical background of Japanese patients with type 1 diabetes mellitus who have received insulin therapy for 50 years or longer. Diabetol Int. 2019;10(4):288-94. PMID: 31592405. PMCID: PMC6763551. https://doi.org/10.1007/s13340-019-00393-x.
Vaisar T, Kanter JE, Wimberger J, et al. High concentration of medium-sized
HDL particles and enrichment in HDL paraoxonase 1 associated with protection from vascular complications in people with longstanding type 1 diabetes. Diabetes Care. 2020;43(1):178-86. https://www.ncbi.nlm.nih.gov/pubmed/31597668. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925582. https://doi.org/10.2337/dc19-0772.
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