Type 2 diabetes in children can have an autoimmune component

Most practitioners and parents think of type 2 diabetes (T2DM) as a metabolic disorder that emerges when the pancreas can no longer keep up with the increasing need for insulin as receptor resistance grows worse. There is growing evidence that T2DM in children and adults is in many cases complicated by the same autoimmune phenomena as in type 1 diabetes. A study just published in the journal Diabetes Care adds to the evidence. The authors set out to:

"...determine the frequency of islet cell autoimmunity in youth clinically diagnosed with type 2 diabetes and describe associated clinical and laboratory findings."

They screened 1,206 children ages (10-17) who were known to have type 2 diabetes for GAD-65 and insulinoma-associated protein 2 autoantibodies using the new National Institute of Diabetes and Digestive and Kidney Diseases/National Institutes of Health (NIDDK/NIH) standardized assays, performed physical examinations, and measured fasting lipids, C-peptide, and HgbA1C. What did the data show?

"Of the 1,206 subjects screened and considered clinically to have type 2 diabetes, 118 (9.8%) were antibody positive...Diabetes autoantibody (DAA) positivity was significantly associated with race, with positive subjects more likely to be white (40.7 vs. 19% and male (51.7 vs. 35.7%. BMI, BMI z score, C-peptide, A1C, triglycerides, HDL cholesterol, and blood pressure were significantly different by antibody status. The antibody-positive subjects were less likely to display characteristics clinically associated with type 2 diabetes and a metabolic syndrome phenotype..."

A clinical 'pearl' embedded here is that if a youth with T2DM does not have the characteristics of metabolic syndrome (overweight, etc.), there is strong suspicion of an autoimmune component to their condition. This must, however, be determined by a blood test for the autoantibodies. The authors conclude:

"Obese youth with a clinical diagnosis of type 2 diabetes may have evidence of islet autoimmunity contributing to insulin deficiency. As a group, patients with DAA have clinical characteristics significantly different from those without DAA. However, without islet autoantibody analysis, these characteristics cannot reliably distinguish between obese young individuals with type 2 diabetes and those with autoimmune diabetes."