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Lee, Kim, Kim, Jeong, Jeong, Kim, Cho, Koh, Kim, Park, and Lee: Anti-GAD Antibody in Patients with Adult-Onset Diabetes in Korea
Original Article
Korean Diabetes Journal

Korean Diabetes Journal 2009; 33(1): 16-23.

Published online: 28 February 2009

DOI: https://doi.org/10.4093/kdj.2009.33.1.16

Anti-GAD Antibody in Patients with Adult-Onset Diabetes in Korea

Sang Ah Lee, Eui Young Kim, Eun Hee Kim, Ji Yun Jeong, Eun Heui Jeong, Dong Woo Kim, Eun Hee Cho, Eun Hee Koh, Min Seon Kim, Joong Yeol Park, Ki-Up Lee

Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.

kulee@amc.seoul.kr

Received 16 June 2008       Accepted 19 August 2008

Copyright © 2009 Korean Diabetes Association

Abstract

Background

It is well known that the clinical characteristics of diabetes mellitus in Korean people are different from those of Western people. The purpose of this study was to investigate the prevalence of the anti-GAD antibody (GADA) in a large number of Korean patients with adult-onset diabetes.

Methods

The GADA was measured by radioimmunoassay for 11,472 adult-onset diabetic patients who visited the Asan Medical Center from 1998 to 2007. According to the fasting C-peptide levels, we classified the patients into an insulin dependent diabetes mellitus group (IDDM; C-peptide < 0.6 ng/mL) and non-insulin dependent diabetes mellitus group (NIDDM; C-peptide ≥ 1.0 ng/mL). Other clinical and laboratory data were obtained from medical records.

Results

Among the 11,147 diabetic patients, 9,250 patients were classified as NIDDM, 922 patients were classified as IDDM and 975 patients excluded. Within the latter group 472 patients were to absolute insulin deficient (C-peptide < 0.1 ng/mL). The prevalence of GADA was 22.0% in the IDDM group and 4.7% in the NIDDM group. GADA was more prevalent in younger-onset NIDDM patients (25~40 years of age; 12.4%) than in older-onset NIDDM patients (≥ 40 years of age; 3.8%). The GADA-positive NIDDM patients had lower C-peptide and BMI levels, and higher rates of typical diabetic symptoms and insulin treatment.

Conclusion

The prevalence of GADA in Korean patients with IDDM and NIDDM was lower than that reported in Western populations. It is thus suggested that autoimmunity is a rarer cause of diabetes in Korean people. However, since over 10% of younger-onset NIDDM patients were positive for GADA, routine GADA measurement in such patients is recommended.

Keywords: Diabetes mellitus, Glutamic acid decarboxylase, Korea, Prevalence

Figures and Tables

Fig. 1
Anti-GAD antibody titer in diabetic patients according to the onset-age. Among NIDDM patients, those who were diagnosed before 40 years of age had higher titer of Anti-GAD antibody than those diagnosed after 40 years of age. *P < 0.05. GAD, glutamic acid decarboxylase; IDDM, insulin dependent diabetes mellitus; NIDDM, non-insulin dependent diabetes mellitus.
kdj-33-16-g001
Table 1
Demographic characteristics of study subjects according to the status of Anti-GAD antibody
kdj-33-16-i001

The data represent the mean ± SEM. *P < 0.05 vs. GAD Ab negative patients. BMI, body mass index; F, female; GAD Ab, Anti-GAD (glutamic acid decarboxylase) antibody; IDDM, insulin dependent diabetes mellitus; M, male; NIDDM, non-insuiln dependent diabetes mellitus.

Table 2
Prevalence of Anti-GAD antibody among patients with NIDDM and IDDM according to the onset-age
kdj-33-16-i002

*P < 0.05 vs. onset-age ≥ 40. GAD, glutamic acid decarboxylase; IDDM, insulin dependent diabetes mellitus; NIDDM, non-insulin dependent diabetes mellitus.

Table 3
Clinical characteristics of anti-GAD antibody positive and negative NIDDM patients
kdj-33-16-i003

The data represent the mean ± SEM. Ab, antibody; BMI, body mass index; DM, diabetes mellitus F, female; GAD, glutamic acid decarboxylase; HbA1c, hemoglobin A1c; NS, not significant.

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