Lifestyle Intervention in Senior Diabetics (LISD) Subanalysis—Autoimmune Profile in the Overweight/Obese Elderly

Introduction: The LISD trial assesses the effects of intensive lifestyle intervention (ILI) in older adults w/T2D on glycemic control, physical function, and QoL. Within the LISD framework, we examined the autoimmune profile before and after intervention. Methods: The LISD study is a RCT of 100 individuals w/T2D that are ≥65 year old w/BMI ≥27 who were randomized to healthy control vs. ILI. ILI included 6m of 3x weekly supervised exercise and dietary counseling followed by 6m of community exercise and dietary monitoring. The following were performed at baseline, 6m, and 12m: GAD ab, ZnT8 ab, IA-2FL ab, serum cytokines via MESO QuickPlex, and 2 hour frequently sampled OGTT. Results: 4/100 participants were + for IA-2FL ab (M: 0.369±0.104) and none for GAD or ZNT8 ab. Compared to IA-2FL - participants, IA-2FL + participants had lower age (68 vs. 71yo; p=0.001), BMI (32 vs. 35; p=0.001), and insulin secretion (Homa-β 68.7 vs. 227.6; p=0.02 Disposition Index: 729 vs. 6049; p=0.009). There was no difference (pu003e0.05) in insulin sensitivity (Homa-IR 7.2 vs. 12.1; Matsuda: 2.9 vs. 2.3), hgbA1c (7.3 vs. 7.7), DM duration (15.2 vs. 13.5yr), or need for insulin therapy (1/4 vs. 38/96). 3/4 IA-2FL + participants were randomized to ILI (weight loss of -9.5 and -11.1% at 6m/12m). Changes in IA-2FL titers did not correlate w/changes in body weight or metabolic parameters. Conclusion: It is thought that the incidence of autoimmune DM in adults has been underestimated, which has led to focus on LADA pathogenesis/prevalence in recent literature. However, the obese elderly population has yet to be examined. Some postulate that obesity/aging leads to inflammation that could be a nidus for autoimmune DM. Interestingly in this understudied population, we found that ab+ status correlates w/a lower BMI, age, and insulin secretion for the same level of glycemic control. Our study serves as a pilot to further investigate autoimmunity in terms of prevalence, phenotype, and pathogenesis of this process in the obese elderly with T2D. Disclosure T. Cubb: None. M.J. Acevedo-Calado: None. A. Celli: None. G. Colleluori: None. U.D. Phadnis: None. M. Pietropaolo: None. D. Villareal: None.