Clinical and Biological Characteristics of Patients Aged 65 and Older with Newly Developed Type 1 Diabetes

Abstract

Objective: Diabetes of elder subjects is characterized by onset after the age of 65, absence of Ketoacidosis, insulin independence for at least 6 months, and presence of circulating islet-cell antibodies. Its marked heterogeneity in clinical features and immunological markers suggests the existence of multiple mechanisms underlying its pathogenesis. Methods: This is a retrospective study related to the observation of 5 patients aged over 65 years old, diagnosed with diabetes. All patients have had a dosage of pancreatic antibodies: anti glutamic acid decarboxylase antibodies (GAD antibodies) and tyrosine phosphatase antibodies IA2 (IA2 antibodies), with positivity to at least one of them. Their clinical and biological data, namely clinical aspects, family and personal history, metabolic and biological profile, autoimmune context, and degenerative complications, have been determined at the moment of the diagnosis. Results: This study was carried out on 4 female patients and one male, with an age between 65 and 71 years with a mean of 68 years. The clinical diagnosis is dominated by an insulinopenia in 3 cases with cardinal syndrome, an average blood glucose at admission=17.88 mmol/L, and an average HbA1C=13.24%. This insulinopenia has occurred in 2 cases immediately, realizing an inaugural ketosis. As far as the other 3 cases are concerned, the insulinopenia has taken place, right after a monitored oral anti-diabetic treatment for an average period of 21 months, fulfilling slow Mellitus Diabetes. An average BMI of 25.8 (Extremities 19 and 39) and a waist circumference>80 cm among all patients (range: minimum: 80, maximum 117 cm) with an average of 92.4 cm are also noted. Retinopathy has been recorded among one female patient. Pancreatic antibodies are all directed against GAD-65 antigen while IA-2 antibodies are found negative. Conclusions: These observations suggest that auto immune Diabetes is possible among the elderly subjects. The absence of any autoimmune context associated with insulin resistance stigma indicates a specific pathophysiology of pancreatic autoimmunity among the elderly subjects. It emphasizes the importance of testing for an appropriate classification of persons with Elder Diabetes. Early diagnosis of LADA would help direct appropriate therapy to optimize glycemic control.