Antibodies to Glutamic Acid Decarboxylase Reveal Latent Autoimmune Diabetes Mellitus in Adults With a Non—Insulin-Dependent Onset of Disease
Antibodies to Glutamic Acid Decarboxylase Reveal Latent Autoimmune Diabetes Mellitus in Adults With a Non—Insulin-Dependent Onset of Disease
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DOI：
10.2337/diab.42.2.359
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发表时间：
1993-02
期刊：
影响因子：
7.7
通讯作者：
T. Tuomi;L. Groop;P. Zimmet;M. Rowley;W. Knowles;I. Mackay
中科院分区：
文献类型：
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作者：
T. Tuomi;L. Groop;P. Zimmet;M. Rowley;W. Knowles;I. Mackay
对于最初表现为NIDDM但后来明显依赖胰岛素的患者，成人糖尿病的分类可能会无效。在其中一些中，发病机制可能与IDDM相似，即胰腺β细胞的自身免疫性破坏。我们研究了102例发病时年龄>35岁的糖尿病患者，这些患者最初无酮症和非胰岛素依赖性≥6个月。根据胰高血糖素刺激的C肽水平将他们分为胰岛素缺乏组（n = 33）和非胰岛素缺乏组（n = 69）。我们测量了两组中的GAD抗体、胰岛细胞胞质、甲状腺抗原和胃壁细胞。胰岛素缺乏组的抗GAD抗体（76%，33例中有25例）显著高于非胰岛素缺乏组（12%，69例中有8例），该差异显著大于ICA。因此，在一定比例的成年人谁目前与NIDDM，一个缓慢发展的自身免疫性胰岛炎可以揭示测试抗GAD。这不仅对早期干预，而且对糖尿病的正确分类具有重要意义。
The classification of adults with diabetes mellitus can be invalidated by patients who initially present as NIDDM but who later become frankly insulin dependent. In some of these, the pathogenesis could be similar to that in IDDM, namely autoimmune destruction of the pancreatic β-cells. We studied 102 patients >35 yr of age at diabetes onset who had initially been nonketotic and non-insulin-dependent for ≥6 mo. They were classified according to glucagonstimulated C-peptide levels into an insulin-deficient group (n = 33) and a non-insulin-deficient group (n = 69). We measured antibodies to GAD, islet cell cytoplasm, thyroid antigens, and gastric parietal cells in both groups. Anti-GAD was significantly higher in the insulin deficient group, 76% (25 of 33), than in the non-insulin deficient group, 12% (8 of 69), and this difference was substantially greater than that shown for ICAs. Thus, in a proportion of adults who present with NIDDM, a slowly evolving autoimmune insulitis can be revealed by testing for anti-GAD. This could have important connotations not only for early intervention, but also for the correct classification of diabetes.