Published: 2022-10-28

A study of prevalence of autoantibodies in lean or underweight diabetic subjects in Southern Rajasthan

Sandeep Kansara, Akhlaq Hasan, Shuchi Goyal


Background: The prevalence of diabetes mellitus (DM) is increasing day by day. Changing life style and unhealthy eating habits are major contributor to this pandemic, however certain individuals develop diabetes despite enough physical activity and low to normal body weight, even in absence of family history. The current study aimed to assess the autoantibody profile of these underweight/lean diabetic subjects, in order to better understand their aetiology.

Methods: This cross sectional, observational study was carried out in endocrinology OPD and ward of RNT Medical College, Udaipur, Rajasthan (India). The study included consecutive 207 lean/underweight diabetic subjects, on insulin or oral antidiabetic drugs (OAD), with or without history of ketosis and negative family history of diabetes. After detailed history and anthropometric examination, subjects were screened for presence of autoantibodies to GAD, TPO and IgA tTG.

Results: 9 subjects were excluded from analysis (7 pancreatic calcification, 2 incomplete data). Out of 198 subjects, 153 (77.3%) subjects tested positive for GAD antibodies, while Anti TPO and IgA anti tTG antibodies were positive in 50 (25.3%) and 6 (3.0%) subjects, respectively. 39 (19.69%) subjects tested positive for both anti GAD and anti TPO antibodies and only 1(0.505%) subject had all the 3 antibodies present. Of the total study population, 158 (79.8%) subjects were on insulin, while 13 (6.6%) subjects received OAD, and 27 (13.6%) subjects both insulin and OAD.

Conclusions: Lean/underweight diabetic subjects with negative family history of diabetes should be screened for presence of autoimmune markers for type 1 diabetes mellitus, irrespective of their treatment.


GAD, Lean diabetes, TPO

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Diabetes mellitus. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1985;727:1-113.

Hoet JJ, Tripathy BB. Consensus statement from the international workshop on types of diabetes peculiar to the tropics, 17-19 October 1995, in Cuttack, India. Acta Diabetol. 1996;33:62-4

Mohan V, Alberti KGMM. Diabetes in the tropics. In: DeFronzo RA, Ferrannini E, Zimmet P, Alberti G, eds. International textbook of diabetes mellitus. John Wiley and Sons; 1991:177-196

Zimmet PZ, Tuomi T, Mackay IR, autoimmune diabetes mellitus in adults (LADA): The role of anti-bodies to glutamic acid decarboxylase in diagnosis and prediction of insulin dependency. Diabetes Med. 1994;11:299-303.

Mohan V, Vijayaprabha R, Rema M, Premalatha G, Poongothai S, Deepa R, et al. Clinical profile of lean NIDDM in South India. Diabetes Res Clin Pract. 1997;38(2):101-8. Erratum in: Diabetes Res Clin Pract. 1998;41(2)149-50.

Unnikrishnan R, Anjana RM, Mohan V. Diabetes in south Asians: is the phenotype different? Diabetes. 2014;63(1):53-5.

Mayega RW, Guwatudde D, Makumbi F, Nakwagala FN, Peterson S, Tomson G, et al. Diabetes and pre-diabetes among persons aged 35 to 60 years in eastern Uganda: prevalence and associated factors. PloS One. 2013;8(8):e72554.

Bahendeka S, Wesonga R, Mutungi G, Muwonge J, Neema S, Guwatudde D (2016) Prevalence and correlates of diabetes mellitus in Uganda: a population-based national survey. Trop Med Int Health. 2016;21(3):405-16.

Animaw W, Seyoum Y (2017) Increasing prevalence of diabetes mellitus in a developing country and its related factors. PLoS One. 2017;12(11):e0187670.

Gujral UP, Mohan V, Pradeepa R, Deepa M, Anjana RM, Narayan KM. Ethnic differences in the prevalence of diabetes in underweight and normal weight individuals: the CARRS and NHANES studies. Diabetes Res Clin Pract. 2018;146:34-40.

Kibirige D, Sekitoleko I, Lumu W, Jones AG, Hattersley AT, Smeeth L, et al. Understanding the pathogenesis of lean non-autoimmune diabetes in an African population with newly diagnosed diabetes. Diabetologia. 2022;65(4):675-83.

Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, et al. Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR–INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol. 2017;5(8):585-96.

Narayan KV, Kondal D, Daya N, Gujral UP, Mohan D, Patel SA, et al. Incidence and pathophysiology of diabetes in South Asian adults living in India and Pakistan compared with US blacks and whites. BMJ Open Diabetes Res Care. 2021;9(1):e001927.

Ahuja MM. Diabetes-special problems in developing countries. Bull Deliv Health Care Diabetics Develop Countries 1980;1:5-6.

Singh AK, Bhatia E, Dabadghao P, Bhatia V, Gellert SA, Colman PG. Role of islet autoimmunity in the aetiology of different clinical subtypes of diabetes mellitus in young north Indians. Diabetes Med. 2000;17(4):275-80.

Fekadu S, Yigzaw M, Alemu S, Dessie A, Fieldhouse H, Girma T, et al. Insulin-requiring diabetes in Ethiopia: associations with poverty, early undernutrition and anthropometric disproportion. Eur J Clin Nutr. 2010;64:1192-8.

Singh S, Singh G, Agrawal NK, Singh RG, Kumar SB. Prevalence of autoantibodies and HLA DR, DQ in type 1 diabetes mellitus. J Clin Diagn Res. 2016;10(7):EC09.

Pulikkal AA, Kolly A, Prasanna Kumar KM, Shivaprasad C. The seroprevalence of immunoglobulin A transglutaminase in type 1 diabetic subjects of South Indian origin. Indian J Endocrinol Metab. 2016;20(2):233-7.

Hoffman DJ, Reynolds RM, Hardy DB. (2017) Developmental origins of health and disease: current knowledge and potential mechanisms. Nutr Rev. 2017;75(12):951-70.

Mandy M, Nyirenda M. Developmental origins of health and disease: the relevance to developing nations. Int Health. 2018;10(2):66-70.