A case of latent autoimmune diabetes in the young positive for zinc transporter 8 antibody with type 2 diabetes characteristics

Takaaki Matsuda; Yoshinori Osaki; Nao Soma; Takayo Azuma; Aya Ezura; Yuta Mitani; Yuichi Kikuchi; Nako Matsumoto; Yuki Murayama; Yoko Sugano; Hitoshi Iwasaki; Bryan J. Mathis; Motohiro Sekiya; Hitoshi Shimano

doi:10.1297/cpe.2024-0083

Takaaki Matsuda, Yoshinori Osaki, Nao Soma, Takayo Azuma, Aya Ezura, Yuta Mitani, Yuichi Kikuchi, Nako Matsumoto, Yuki Murayama, Yoko Sugano, Hitoshi Iwasaki, Bryan J. Mathis, Motohiro Sekiya, Hitoshi Shimano

Author information

Takaaki Matsuda
Department of Endocrinology and Metabolism, University of Tsukuba Hospital, Ibaraki, Japan
Yoshinori Osaki
Department of Endocrinology and Metabolism, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
Nao Soma
Department of Endocrinology and Metabolism, University of Tsukuba Hospital, Ibaraki, Japan
Takayo Azuma
Department of Endocrinology and Metabolism, University of Tsukuba Hospital, Ibaraki, Japan
Aya Ezura
Department of Endocrinology and Metabolism, University of Tsukuba Hospital, Ibaraki, Japan
Yuta Mitani
Department of Endocrinology and Metabolism, University of Tsukuba Hospital, Ibaraki, Japan
Yuichi Kikuchi
Department of Endocrinology and Metabolism, University of Tsukuba Hospital, Ibaraki, Japan
Nako Matsumoto
Department of Endocrinology and Metabolism, University of Tsukuba Hospital, Ibaraki, Japan
Yuki Murayama
Department of Endocrinology and Metabolism, University of Tsukuba Hospital, Ibaraki, Japan
Yoko Sugano
Department of Endocrinology and Metabolism, University of Tsukuba Hospital, Ibaraki, Japan
Hitoshi Iwasaki
Department of Endocrinology and Metabolism, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
Bryan J. Mathis
Department of Cardiovascular Surgery, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
Motohiro Sekiya
Department of Endocrinology and Metabolism, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
Hitoshi Shimano
Department of Endocrinology and Metabolism, Institute of Medicine, University of Tsukuba, Ibaraki, Japan

Keywords: latent autoimmune diabetes in the young, slowly progressive insulin-dependent diabetes mellitus, autoantibodies, glutamate decarboxylase, zinc transporter 8

JOURNAL OPEN ACCESS Advance online publication

Article ID: 2024-0083

DOI https://doi.org/10.1297/cpe.2024-0083

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Abstract

Latent autoimmune diabetes in the young (LADY), also known as slowly progressive insulin-dependent diabetes mellitus (SPIDDM), is a slowly progressive form of type 1 diabetes (T1D) characterized by positive islet-related autoantibodies and, typically, an initial type 2 diabetes (T2D) phenotype. Although approximately 10% of children with T2D have positive islet-related autoantibodies, reports on the clinical course of patients with LADY are limited. We present the case of a 17-yr-old female initially diagnosed with T2D based on a body mass index (BMI) of 27 kg/m², obesity, and preserved endogenous insulin secretion. Notably, the glutamic acid decarboxylase antibody (GADA) test results fluctuated between weakly positive and negative. She developed diabetic ketosis 9 mo later, with a weak GADA titer and a high zinc transporter 8 antibody (Zn-T8A) titer, confirming autoimmune β-cell destruction consistent with T1D. Subsequent human leukocyte antigen (HLA) testing revealed the presence of the DRB1*15:02-DQB1*06:01 haplotype, which is considered protective against T1D. This case report details the clinical course of LADY, emphasizes close follow-up and re-evaluation of multiple islet-related autoantibodies in patients to distinguish LADY from T2D, and suggests that a protective HLA haplotype may have contributed to the slow onset despite high-titer Zn-T8A.

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