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Diabetes Res Clin Pract. 2019 Oct 24;158:107894. doi: 10.1016/j.diabres.2019.107894. [Epub ahead of print]

Clinical features, biochemistry and HLA-DRB1 status in children and adolescents with diabetes in Dhaka, Bangladesh.

Author information

1
Department of Changing Diabetes in Children, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh.
2
Life for a Child Program, Diabetes NSW, Glebe, NSW 2037, Australia; Sydney Medical School, University of Sydney, NSW 2006, Australia. Electronic address: dgov8678@uni.sydney.edu.au.
3
Dept of Physiology and Molecular Biology, Bangladesh University of Health Sciences (BUHS), Mirpur-1, Dhaka, Bangladesh & Dept of Physiology, Tairunnessa Memorial Medical College, Gazipur, Bangladesh. Electronic address: mzhassan@buhs.ac.bd.
4
Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA. Electronic address: jnoble@chori.org.
5
Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA. Electronic address: howlane@sbcglobal.net.
6
Children's Hospital Oakland Research Institute, Oakland, CA 94609, USA. Electronic address: sjmack@chori.org.
7
Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA; Department of Pediatrics, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA. Electronic address: atkinson@ufl.edu.
8
Department of Changing Diabetes in Children, Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh. Electronic address: pcp@dab-bd.org.
9
Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 32610, USA. Electronic address: wasserfa@pathology.ufl.edu.
10
Sydney Medical School, University of Sydney, NSW 2006, Australia; Diabetes NSW, Sydney, Australia. Electronic address: grahamo@diabetesnsw.com.au.

Abstract

AIMS:

Little information is published on diabetes in young people in Bangladesh. We aimed to investigate the demographic, clinical, and biochemical features, and HLA-DRB1 alleles in new cases of diabetes affecting Bangladeshi children and adolescents <22 years of age.

METHODS:

The study was conducted at Bangladesh Institute of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders (BIRDEM) in Dhaka. One hundred subjects aged <22 years at diagnosis were enrolled. Demographic characteristics, clinical information, biochemical parameters (blood glucose, HbA1c, C-peptide, and autoantibodies against glutamic acid decarboxylase 65 (GADA) and islet antigen-2 (IA-2A) were measured. High-resolution DNA genotyping was performed for HLA-DRB1.

RESULTS:

Eighty-four subjects were clinically diagnosed as type 1 diabetes (T1D), seven as type 2 diabetes (T2D), and nine as fibrocalculous pancreatic disease (FCPD). Of the 84 with T1D, 37 (44%) were males and 47 (56%) females, with median age at diagnosis 13 years (y) (range 1.6-21.7) and peak age at onset 12-15 years. 85% of subjects were assessed within one month of diagnosis and all within eleven months. For subjects diagnosed with T1D, mean C-peptide was 0.46 ± 0.22 nmol/L (1.40 ± 0.59 ng/mL), with 9 (10.7%) IA-2A positive, 22 (26%) GADA positive, and 5 (6%) positive for both autoantibodies. Analysis of HLA-DRB1 genotypes revealed locus-level T1D association (p = 6.0E-05); DRB1*04:01 appeared predisposing (p < 3.0E-06), and DRB1*14:01 appeared protective (p = 1.7E-02).

CONCLUSIONS:

Atypical forms of T1D appear to be more common in young people in Bangladesh than in European populations. This will be helpful in guiding more specific assessment at onset and potentially, expanding treatment options.

KEYWORDS:

Autoantibody; Autoimmunity; Bangladesh; C-peptide; Childhood diabetes; Children; Diabetes; HLA; Type 1 diabetes

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