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Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS: 23)

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7134.823 (Published 14 March 1998) Cite this as: BMJ 1998;316:823

To find the actual risk factors for coronary artery disease in non-insulin dependent diabetes mellitus, influence of the LADA patients should be removed

UKPDS23 [1] identifies a quintet of potentially modifiable risk
factors of coronary artery disease applicable for the selected sample. How
ever as the selected sample had LADA (Latent autoimmune diabetes in
adults) patients as well, these factors are not likely to represent the
real risk levels of type 2 diabetic patients. According to some other
publications from the (United Kingdom Prospective Diabetes Study) UKPDS
actual influence of the presence of LADA patients seems to be quite high.

Data given in the ESM (Electronic Supplementary Material) Fig1 of
UKPDS77 [2] is directly related to the UKPDS23 sample as the patients
selected are White Caucasians. Findings of the UKPDS77 provides a clear
message that correct percentage of LADA patients in a trial cannot be
computed from the data collected at the beginning of the trial as
reasonable part of the patients may not show sufficient volume of
antibodies in the earlier stage of decease onset. As shown in ESM in
addition to originally identified 526 patients another 166 patients should
be identified as LADA as they had sufficient percentage of antibodies in
the blood samples taken on subsequent occasions. Therefore total
percentage of LADA patients among white Caucasians should be corrected to
a minimum figure of 692 out of 4145 or 17%. It is to be noted that some
more patients are likely to show sufficient quantity of antibodies to
qualify for LADA categorization even after six years.

According to UKPDS70 [3] LADA patients included in the UKPDS sample
(93% White Caucasians) had characteristics some what different from the
Type 2 diabetic patients.

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Characteristic----------------------------: LADA / TYPE 2

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Systolic blood pressure (mmHg)----:129/136

HbA1c-------------------------------------:7.4%/6.9%

Smoking Ex: never----------------------:(30:35)/(34:31)

Plasma LDL cholesterol (mmol/l)----:3.4/3.5

Plasma HDL cholesterol (mmol/l)----:1.10/1.07

Proportion with metabolic syndrome:42%/59%

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As the UKPDS23 sample consisted of patients without evidence of
disease related to Atheroma, actual percentage of LADA patients in the
sample is likely to be much higher than the 17%. Therefore reasonably high
level of LADA patients should be there in the age <50 category,
Systolic blood pressure <125category and the HbA1c>7.5 category.

Having found the existence of very high percentage of LADA patients
among diabetic patients in the UKPDS23 sample ,it is extremely useful to
separate LADA patients and non LADA diabetic patients in to two groups to
obtain the actual risk factors.

References

1.R C Turner, H Millns, H A W Neil, I M Stratton, S E Manley, D R
Matthews, and R R Holman
Risk factors for coronary artery disease in non-insulin dependent diabetes
mellitus: United Kingdom prospective diabetes study (UKPDS: 23)
BMJ, Mar 1998; 316: 823 – 828

2. GAD auto antibodies and epitope reactivities persist after
diagnosis in latent autoimmune diabetes in adults but do not predict
disease progression: UKPDS 77 Desai M, Cull CA, Horton VA, Christie MR,
Bonifacio E, Lampasona V, Bingley PJ, Levy JC, mackay IR, Zimmet P, Holman
RR, Clark A. Diabetolgia 2007

3. Davis TM Wright AD, Mehta ZM et al (2005) Islet auto antibodies in
clinically diagnosed type 2 diabetes: prevalence and relationship with
metabolic control (UKPDS 70). Diabetologia 48:695-702

Competing interests:
None declared

Competing interests: No competing interests

26 February 2008
Arya K Kumarasena
Consultant/Director
85 ,Braybrroke ,place colombo2,Sri Lanka