Heterogeneity in the aetiology of diabetes mellitus in young adults: A prospective study from north India.
Aetiological heterogeneity
C-peptide
early-onset diabetes
fibrocalculous pancreatic diabetes
islet antibodies
Journal
The Indian journal of medical research
ISSN: 0971-5916
Titre abrégé: Indian J Med Res
Pays: India
ID NLM: 0374701
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
entrez:
15
8
2019
pubmed:
15
8
2019
medline:
23
1
2020
Statut:
ppublish
Résumé
In contrast to Caucasians of European origin, the aetiology of diabetes mellitus (DM) in young adults in other ethnic groups, including Indians is likely to be heterogeneous and difficult to determine. This study was undertaken to determine the aetiology of diabetes in young Indian adults using a protocol-based set of simple clinical and investigation tools. In this prospective study, 105 Indian young adults with diabetes (age at onset 18-35 yr; duration <2 yr) were studied for a period of 1-3 years. Pancreatic imaging, fasting C-peptide, islet antibodies (against glutamic acid decarboxylase, tyrosine phosphatase and zinc transporter-8) and mitochondrial A3243G mutational analysis were performed in all patients. Four patients were screened for maturity-onset diabetes of the young (MODY) using next-generation sequencing. Type 1 and type 2 diabetes mellitus (T1DM and T2DM) were equally frequent (40% each), followed by fibrocalculous pancreatic diabetes (FCPD, 15%). Less common aetiologies included MODY (2%), mitochondrial diabetes (1%) and Flatbush diabetes (2%). There was considerable phenotypic overlap between the main aetiological subtypes. Elevated islet antibodies were noted in 62 per cent of T1DM patients [positive predictive value (PPV) 84%; negative predictive value (NPV) 78%] while low plasma C-peptide (<250 pmol/l) was present in 56 per cent of T1DM patients [PPV 96% (after excluding FCPD), NPV 72%]. Using these tests and observing the clinical course over one year, a final diagnosis was made in 103 (99%) patients, while the diagnosis at recruitment changed in 23 per cent of patients. The aetiology of diabetes in young adults was heterogeneous, with T1DM and T2DM being equally common. FCPD was also frequent, warranting its screening in Indian patients. Testing for islet antibodies and C-peptide in this age group had good PPV for diagnosis of T1DM.
Sections du résumé
Background & objectives
In contrast to Caucasians of European origin, the aetiology of diabetes mellitus (DM) in young adults in other ethnic groups, including Indians is likely to be heterogeneous and difficult to determine. This study was undertaken to determine the aetiology of diabetes in young Indian adults using a protocol-based set of simple clinical and investigation tools.
Methods
In this prospective study, 105 Indian young adults with diabetes (age at onset 18-35 yr; duration <2 yr) were studied for a period of 1-3 years. Pancreatic imaging, fasting C-peptide, islet antibodies (against glutamic acid decarboxylase, tyrosine phosphatase and zinc transporter-8) and mitochondrial A3243G mutational analysis were performed in all patients. Four patients were screened for maturity-onset diabetes of the young (MODY) using next-generation sequencing.
Results
Type 1 and type 2 diabetes mellitus (T1DM and T2DM) were equally frequent (40% each), followed by fibrocalculous pancreatic diabetes (FCPD, 15%). Less common aetiologies included MODY (2%), mitochondrial diabetes (1%) and Flatbush diabetes (2%). There was considerable phenotypic overlap between the main aetiological subtypes. Elevated islet antibodies were noted in 62 per cent of T1DM patients [positive predictive value (PPV) 84%; negative predictive value (NPV) 78%] while low plasma C-peptide (<250 pmol/l) was present in 56 per cent of T1DM patients [PPV 96% (after excluding FCPD), NPV 72%]. Using these tests and observing the clinical course over one year, a final diagnosis was made in 103 (99%) patients, while the diagnosis at recruitment changed in 23 per cent of patients.
Interpretation & conclusions
The aetiology of diabetes in young adults was heterogeneous, with T1DM and T2DM being equally common. FCPD was also frequent, warranting its screening in Indian patients. Testing for islet antibodies and C-peptide in this age group had good PPV for diagnosis of T1DM.
Identifiants
pubmed: 31411171
pii: IndianJMedRes_2019_149_4_479_262869
doi: 10.4103/ijmr.IJMR_1004_17
pmc: PMC6676834
doi:
Substances chimiques
C-Peptide
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
479-488Commentaires et corrections
Type : CommentIn
Déclaration de conflit d'intérêts
None
Références
Diabetologia. 2000 Apr;43(4):450-6
pubmed: 10819238
Diabetologia. 2008 Aug;51(8):1368-74
pubmed: 18528678
Lancet. 2005 Sep 24-30;366(9491):1059-62
pubmed: 16182882
J Clin Endocrinol Metab. 2006 Nov;91(11):4256-9
pubmed: 16895958
Endocr Rev. 2008 May;29(3):292-302
pubmed: 18292467
Diabetes Care. 2012 Jun;35(6):1206-12
pubmed: 22432108
Diabetologia. 2003 Feb;46(2):173-81
pubmed: 12627315
Indian J Pediatr. 2016 Aug;83(8):792-8
pubmed: 26816135
Autoimmunity. 2013 Jun;46(4):251-8
pubmed: 23194113
Diabetes Care. 2005 Nov;28(11):2613-9
pubmed: 16249528
Diabetes Care. 1985 Mar-Apr;8(2):114-7
pubmed: 3873328
Diabet Med. 2000 Apr;17(4):275-80
pubmed: 10821293
Lancet Glob Health. 2018 Dec;6(12):e1352-e1362
pubmed: 30219315
Diabetes Care. 2015 Oct;38(10):e164-5
pubmed: 26289561
Diabet Med. 2004 Sep;21(9):1007-13
pubmed: 15317606
Diabetes Care. 2003 Jul;26(7):2088-93
pubmed: 12832318
J Clin Endocrinol Metab. 2009 Jun;94(6):1959-65
pubmed: 19336507
J Clin Endocrinol Metab. 2007 Jul;92(7):2462-7
pubmed: 17440016
Diabetologia. 1999 Sep;42(9):1131-7
pubmed: 10447526
J Gastroenterol Hepatol. 2011 Feb;26(2):378-81
pubmed: 21261730
Diabetes Care. 2003 Feb;26(2):333-7
pubmed: 12547858
Diabetes. 2002 May;51(5):1346-55
pubmed: 11978629
J Diabetes Sci Technol. 2016 Aug 22;10(5):1034-41
pubmed: 27179010
Diabetes Res Clin Pract. 2010 Jan;87(1):4-14
pubmed: 19896746
Nat Genet. 1997 Oct;17(2):138-9
pubmed: 9326926
Diabetologia. 2008 May;51(5):846-52
pubmed: 18373080
J Clin Endocrinol Metab. 2001 Jan;86(1):220-6
pubmed: 11232004
Diabetologia. 1997 Jan;40(1):95-9
pubmed: 9028724
Clin Endocrinol (Oxf). 2015 Apr;82(4):533-42
pubmed: 25041077
Natl Med J India. 2002 Nov-Dec;15(6):327-31
pubmed: 12540065
Ann N Y Acad Sci. 2008 Dec;1150:239-44
pubmed: 19120303
J Postgrad Med. 2001 Jan-Mar;47(1):27-9
pubmed: 11590287
Diabetes Care. 2004 Jul;27(7):1798-811
pubmed: 15220270