Increased cardiovascular risk in people with LADA in comparison to type 1 diabetes and type 2 diabetes: Findings from the DPV registry in Germany and Austria

Abstract

Introduction: We aimed to characterise and compare individuals diagnosed with type 1 diabetes (T1D), latent autoimmune diabetes in adults (LADA) and type 2 diabetes (T2D), in a real-world setting.

Methods: Anthropometric and clinical data from 36 959 people with diabetes diagnosed at age 30-70 years enrolled in the prospective diabetes patients follow-up (DPV) registry from 1995 to 2022 were analysed cross-sectionally at diagnosis and follow-up (≥6 months after diagnosis). LADA was defined as clinical diagnosis of T2D, positivity of ≥1 islet autoantibody and an insulin-free interval of ≥6 months upon diabetes diagnosis.

Results: At diagnosis, age, body mass index, waist circumference, C-peptide and HbA1c in people with LADA (n = 747) fell in between individuals with T1D (n = 940) and T2D (n = 35 272) (all p-values < 0.01). At follow-up, after adjusting for age, sex and diabetes duration, the prevalence of dyslipidemia and hypertension was the highest in people with LADA (90.6%, 77.7%) compared to people with T2D (81.8%, 60.4%) and T1D (75.7%, 39.7%) (p < 0.01). The prevalence of diabetic kidney disease (DKD) was higher in LADA (44.2%), than in T1D (19.9%) (p < 0.01). The prevalence of peripheral neuropathy was higher in individuals with LADA (55.1%) than in T2D (43.9%) and T1D (42.1%) (p < 0.05). Coverage of treatment for hypertension and dyslipidemia were 22.4% and 15.0% in T1D, 63.0% and 36.6% in LADA and 29.4% and 18.2% in T2D.

Conclusion: People with LADA had a higher prevalence of cardiovascular risk factors (dyslipidemia, hypertension) and cardiovascular complications (DKD and peripheral neuropathy), suggesting that people with LADA are at need for improved recognition and care.

Keywords: cardiovascular disease; database research; dyslipidaemia; real‐world evidence; type 1 diabetes; type 2 diabetes.

FIGURE 1

Patient acquisition in diabetes patient follow‐u (DPV) during 1995–2022 in patients diagnosed at age 30–70 years with β‐cell antibody positive type 1 diabetes (T1D) and β‐cell antibody positive latent autoimmune diabetes in adults (LADA) and type 2 diabetes (T2D).

FIGURE 2

Anthropometric and laboratory data at manifestation and during follow‐up. Data are medians (first to third quartiles). Cross‐sectional analysis. Not all patients from manifestation were seen at follow‐up. For n‐values, exact p‐values and numbers see Table 1. Significance is established by p‐values <0.05 through the application of both Wilcoxon rank sum test and the chi‐squared test, adjusted with the Bonferroni–Holm method. * Versus type 1 diabetes (T1D) p‐value < 0.05. ** Versus T1D p‐value < 0.01. ^‡Versus type 2 diabetes (T2D) p‐value < 0.05. ^‡‡Versus T2D p‐value < 0.01. BMI, body mass index; LADA, latent autoimmune diabetes in adults.