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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The concept that idiopathic diabetes mellitus is a genetically heterogeneous group of disorders has been established by twin and HLA studied that have permitted the separation of juvenile-onset and maturity-onset diabetes. The extent of the heterogeneity within the juvenile-onset and maturity-onset types is still in question. On the basis of recent immunologic and metabolic studies we believe that further heterogeneity can be demonstrated within the juvenile-onset diabetic group. We wish to hypothesize that there are at least two distinct forms of juvenile-onset diabetes, one associated with HLA B8 and the other with BW15. The B8 type is characterized by autoimmunity, microangiopathy, and a stronger association with the HLA D locus. The BW15 type is characterized by antibody response to exogenous insulin and a stronger association with the HLA C locus. Greater understanding of the pathogenesis, natural history, and genetics of diabetes mellitus will result as the full extent of genetic heterogeneity is elucidated.
Diabetes 1978 May
PMID:Heterogeneity in diabetes mellitus--update, 1978. Evidence for further genetic heterogeneity within juvenile-onset insulin-dependent diabetes mellitus. 34 39

Sixty-eight patients with longstanding diabetes and persistent islet-cell antibody and 35 with coexistent diabetes and Graves's disease or primary myxoedema were studied with particular reference to the HLA system and autoantibody patterns. A higher incidence of HLA-B8 than normal was observed in the two groups. An additive relative risk exists when type I diabetes and autoimmune thyroid disease coexist, indicating that different HLA-linked genes may confer susceptibility to the pancreatic and thyroid disorders. Other characteristics, including female predominance, a later onset of diabetes, and a strong family history of autoimmune endocrinopathy, provide further evidence that this form of diabetes is aetiologically distinct from that generally seen in children. These results support the hypothesis of a primary autoimmune type of diabetes mellitus.
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PMID:Evidence for a primary autoimmune type of diabetes mellitus. 36 Nov 63

Nineteen insulin dependent diabetics with onset at 30 years of age or less and duration of diabetes of greater than 25 years were divided into two groups on the basis of the presence or absence of clinically evident vascular disease. The patients without vascular disease were characterised by a later mean age of onset, lower fasting growth hormone concentration, and a lower frequency of the unusual HLA pattern B8 without A1 compared to the diabetics with vascular complications. The level of blood glucose control assessed over the last 15 years, insulin antibody titres, plasma glucagon levels and plasma cholesterol did not differ between the two groups. Residual beta cell activity was found in only one of the 19 patients. Although this study does not exclude an effect of the degree of blood glucose control or persistence of beta cell function in the early stages of diabetes on the subsequent development of vascular disease, it suggests that genetic factors, age of onset and plasma growth hormone levels may be more important.
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PMID:Hormonal profile, blood sugar control and HLA patterns in long-term insulin dependent diabetes with and without vascular disease. 36 9

Diabetes mellitus is a syndrome characterised primarily by an increase in blood glucose and an absolute or relative deficiency of insulin. Etiologically, it is a complex disorder because many different genetic, environmental, immunological, metabolic and hormonal influences interact to produce the clinical picture diabetes. By introducing HLA typing in diabetes research in the last four years, it became possible to clearly distinguish between the juvenile-onset, insulin-dependent type and the non-insulin-dependent, maturity-onset type of diabetes mellitus. On the basis of this and other evidence, at least five nosologically distinct types of diabetes can be identified.
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PMID:[New viewpoints on the pathogenesis of diabetes mellitus]. 37 86

Insulin dependent (IDD) and non-insulin dependent diabetes (NIDD) are separate disorders. Twin studies show that IDD cannot be entirely due to genetic causes as concordance is no more than about 50%, but there is some inherited predisposition to it as shown by HLA patterns. NIDD, on the other hand, is predominantly due to genetic causes since identical twins are nearly always concordant. Many cases of NIDD show chlorpropamide alcohol flushing (CPAF), a dominantly inherited feature which may precede the appearance of diabetes and thus act as a genetic marker for this type of diabetes. Diabetics who show chlorpropamide acohol flushing are less likely to develop retinopathy than those who do not. Genetic factors must therefore affect the incidence and severity of diabetic retinopathy. Chlorpropamide alcohol flushing is due to sensitivity to enkephalin. Enkephalin and other opioids affect carbohydrate metabolism and insulin release. It is possible therefore that they act as neurotransmitters and cause NIDD by a sympathetically mediated effect on the liver and pancreas--in other words, that as far as NIDD is concerned Claude Bernard's views on the cause of diabetes may have been right.
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PMID:Diabetes: the genetic connections. 39

The study of a hundred and fifteen unrelated insulin-dependent diabetes and eight families with at least two insulin-dependent diabetes members made it possible to confirm the higher frequency of HLA-B8 and B18 (p less than 0.001) among patients, producing a RR of 2.24 and 2.47 respectively. The increased B15 frequency did not achieve statistical significance. B18 whose gametic association (delta = 0.0438) was significant only in diabetic patients was often related to Aw19-2 (Aw30 + Aw31). The B8/B18 genotype gave a relative risk (RR = 4.98) which was significantly higher than that of B8, B18 and B15 heterozygotes (1.50, 1.24 and 1.39 respectively). Pairs of diabetic siblings were more frequently HLA identical than would be expected by chance, and distribution of the pairs of affected sibs into the three categories, identical, semi-identical and different, was closer to the recessive model than to the dominant one. The fact that the B8/B18 individuals had a RR slightly higher than the B8 and B18 homozygotes and distinctly higher than the heterozygotes for only one of these genes, favours the hypothesis of two dominant genes, giving the appearance of recessivity. The gene associated with B18 in Southern Europe seems to play the same part as that of the gene associated with B15 in Northern Europe.
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PMID:Insulin-dependent diabetes and HLA. 39

Sixteen insulin dependent diabetic patients (age at onset less than 35 years) and their families were tissue typed for HLA antigens. Glucose tolerance of relatives was also tested. Among diabetic patients two HLA antigens were found with increased frequency: B8 (31 percent, control 15 percent) and Bw35 (38 percent, control 23 percent). Among normal relatives B8 and Bw35 had the same frequency as the control group. Bw15 frequency was not increased in either group. In relatives, no correlation between HLA antigens (B8 or Bw35) and abnormal glucose tolerance, obesity and over-weight at birth was found. Present data confirm previous reports of high B8 frequency in early onset diabetic patients, but fail to demonstrate a raised frequency of abnormal glucose tolerance among relatives bearing B8 (or, in our cases, Bw35). B8 may be considered a genetic indicator for susceptibility to juvenile diabetes. On the basis of present results in families, however non genetic factors clearly also play a determinant role. Furthermore, that diabetogenesis arises from a link between Ir-genes and HLA-B8 antigen should only be considered a suggestive hypothesis.
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PMID:HLA antigens and insulin dependent diabetes mellitus. A family study. 41 51

The present study was undertaken to determine the importance of immune region-associated alloantigens for susceptibility to insulin-dependent diabetes (IDD), their possible influence on immunoglobulin G-insulin antibody formation, and their clinical significance. Incidence of DRw3 and DRw4 (HLA D-related immune region-associated alloantigens; w, defined by sera dispensed during the Seventh International Histocompatibility Workshop) was found with significantly increased frequency in the IDD patients (n = 50) compared to healthy individuals (n = 107). Subjects positive for DRw3 carry a 4.5-fold increased risk and those positive for DRw4 carry a 2.5-fold increased risk of developing IDD. By analyzing immunoglobulin G-insulin antibody titers in DRw3-positive and DRw3-negative patients (all treated with conventional Lente insulin), a significant tendency for high insulin-binding capacity (IBC) was noted in the latter group, yielding a mean IBC of 2.24 in DRw3-negative and 0.74 in DRw3-positive diabetics (P less than 0.02). A significantly increased insulin dosage was needed for adequate metabolic control in those patients with high IBC (IBC greater than 3.0 U/liter). Patients with high IBC and high insulin requirements were predominantly found to be DRw3 negative. Our data demonstrate that IDD is more closely associated with DRw3 than with all hitherto described HLA A, B, and C locus alloantigens of the major histocompatibility complex. In addition, these immunogenetic factors seem to be of clinical importance by influencing the humoral antiinsulin immune response.
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PMID:Immunoglobulin G-insulin antibodies and immune region-associated alloantigens in insulin-dependent diabetes mellitus. 42 93

HLA typing was performed in 90 unrelated patients with chronic alcohol-associated pancreatitis. Compared with 523 healthy controls, an increased frequency was found for the HLA-B series antigen, B40 (Pless than 0.00041, corrected P less than 0.011). The increase was slightly more pronounced in patients without pancreatic calcifications than in those with calcifications. Factors such as alcohol consumption, age of disease onset and the presence of diabetes did not affect antigen frequency distribution.
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PMID:HLA antigens in chronic alcoholic pancreatitis. 44 66

The transmission behavior of insulin-dependent juvenile diabetes mellitus (JDM) has been studied with respect to its frequency in the relatives of JDM probands and its possible linkage to the HLA complex. Mathematical analysis shows that under a single locus hypothesis a very restricted range of incidence rates is possible in the full siblings of probands once the concordance rate in monozygotic (MZ) twins is specified. Specifically, for a given population prevalence of the disease, high concordance rates in MZ twins require high incidence rates in siblings, and low rates require low incidence rates, if a single locus model is th be valid. Moreover, if these rates do conform to a single locus model, then they give additional information about possible linkage between the purported JDM susceptibility gene and the HLA complex. By using observations on the identity by descent scores at the HLA locus of sibling pairs, both of whom are affected with JDM, it is shown that tight linkage of a disease susceptibility locus is possible only when the MZ twin and sibling incidence rates are low, whereas high rates support loose linkage. If the single locus model is rejected, then an alternative hypothesis, involving epistasis between a JDM susceptibility locus and genes in (or close to) the HLA complex can be suggested as a mechanism whereby JDM would appear to be linked to HLA within families while maintaining an association with HLA at the population level.
Diabetes 1979 Jun
PMID:Is juvenile diabetes determined by a single gene closely linked to HLA? 44 10


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