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  • Title: Immune-mediated disease and secondary failure to oral therapy in type 2 diabetes mellitus.
    Author: Avilés-Santa L, Maclaren N, Raskin P.
    Journal: J Diabetes Complications; 2004; 18(1):10-7. PubMed ID: 15019594.
    Abstract:
    PURPOSE: To determine the proportion of adults with type 2 diabetes, who developed secondary failure to oral medications that had immune-mediated diabetes (IMD). SUBJECTS AND METHODS: One hundred and eight subjects who failed to oral therapy were screened for autoantibodies (ICA, IAA, IA-2A, and GADA(65)) and HLA DR/DQ markers of IMD. RESULTS: Mean age was 49 years and mean body mass index (BMI) was 31.5 kg/m(2); 21.3% were non-Hispanic White (NHW), 32.3% Latin American (LA), and 43.2% African American (AA). Fourteen percent had one or more autoantibodies [Ab(+)]: five NHW, three LA, and seven AA. Ab(+) patients were younger (P=.03) and had lower body weight (P=.05) than Ab(-) patients. HLA markers of susceptibility for IMD were identified in 64% Ab(+) and in 43% Ab(-) (chi(2), P=.46). CONCLUSIONS: These results suggest that secondary failure to oral therapy can be due to continuing IMD in obese, type 2 diabetic individuals of varying ethnic backgrounds than those who have been traditionally associated with autoimmune type 1 diabetes. Screening for markers for IMD at diagnosis could be a useful way to predict those likely to develop secondary failure to oral therapy and may assist in the selection of medical therapy.
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