Management of Latent Autoimmune Diabetes in Adults: A Consensus Statement From an International Expert Panel.
Management of Latent Autoimmune Diabetes in Adults: A Consensus Statement From an International Expert Panel.
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DOI：
10.2337/dbi20-0017
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发表时间：
2020-10
期刊：
影响因子：
7.7
通讯作者：
Leslie RD
中科院分区：
文献类型：
--
作者：
Buzzetti R;Tuomi T;Mauricio D;Pietropaolo M;Zhou Z;Pozzilli P;Leslie RD
很大一部分成人型糖尿病患者具有1型糖尿病（T1 D）和2型糖尿病（T2 D）的共同特征。这些个体在诊断时，临床上类似于T2 D患者，不需要胰岛素治疗，但他们具有与T1 D相关的免疫遗传标记物。这种缓慢发展的自身免疫性糖尿病形式，被描述为成人隐匿性自身免疫性糖尿病（LADA），占所有成人发病糖尿病患者的2-12%，尽管根据其人口统计学和确定模式，他们显示出相当大的变异性。虽然治疗策略旨在代谢控制和保留残余胰岛素分泌能力，LADA内的内源型异质性意味着个性化的治疗方法。由于缺乏在旱地退化评估中进行的大规模临床试验，一个专家小组审查了数据，并确定了一种治疗方法。基于2020年美国糖尿病协会（ADA）/欧洲糖尿病研究协会（EASD）关于T2 D和自身免疫性糖尿病异质性的共识，我们提出了LADA与这些指南的“偏差”。在LADA中，C肽值（β细胞功能的代表）驱动治疗决策。专家组引入了三大类随机C肽水平：1）C肽水平<0.3 nmol/L：推荐的T1 D多重胰岛素方案; 2）C肽值≥0.3且≤0.7 nmol/L：专家组定义为“灰色区域”，其中推荐T2 D的改良ADA/EASD算法;考虑胰岛素与其他疗法联合使用，以调节β细胞衰竭并限制糖尿病并发症; 3）C肽值>0.7 nmol/L：建议采用与T2 D相同的改良ADA/EASD算法，但通过监测C肽调整治疗，考虑到LADA的潜在进行性。专家组最后建议对新诊断的非胰岛素依赖型糖尿病患者进行LADA的一般筛查，重要的是，需要进行大型随机临床试验。
A substantial proportion of patients with adult-onset diabetes share features of both type 1 diabetes (T1D) and type 2 diabetes (T2D). These individuals, at diagnosis, clinically resemble T2D patients by not requiring insulin treatment, yet they have immunogenetic markers associated with T1D. Such a slowly evolving form of autoimmune diabetes, described as latent autoimmune diabetes of adults (LADA), accounts for 2–12% of all patients with adult-onset diabetes, though they show considerable variability according to their demographics and mode of ascertainment. While therapeutic strategies aim for metabolic control and preservation of residual insulin secretory capacity, endotype heterogeneity within LADA implies a personalized approach to treatment. Faced with a paucity of large-scale clinical trials in LADA, an expert panel reviewed data and delineated one therapeutic approach. Building on the 2020 American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) consensus for T2D and heterogeneity within autoimmune diabetes, we propose “deviations” for LADA from those guidelines. Within LADA, C-peptide values, proxy for β-cell function, drive therapeutic decisions. Three broad categories of random C-peptide levels were introduced by the panel: 1) C-peptide levels <0.3 nmol/L: a multiple-insulin regimen recommended as for T1D; 2) C-peptide values ≥0.3 and ≤0.7 nmol/L: defined by the panel as a “gray area” in which a modified ADA/EASD algorithm for T2D is recommended; consider insulin in combination with other therapies to modulate β-cell failure and limit diabetic complications; 3) C-peptide values >0.7 nmol/L: suggests a modified ADA/EASD algorithm as for T2D but allowing for the potentially progressive nature of LADA by monitoring C-peptide to adjust treatment. The panel concluded by advising general screening for LADA in newly diagnosed non–insulin-requiring diabetes and, importantly, that large randomized clinical trials are warranted.
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影响因子：
16.2
作者：
Cousminer DL;Ahlqvist E;Mishra R;Andersen MK;Chesi A;Hawa MI;Davis A;Hodge KM;Bradfield JP;Zhou K;Guy VC;Åkerlund M;Wod M;Fritsche LG;Vestergaard H;Snyder J;Højlund K;Linneberg A;Käräjämäki A;Brandslund I;Kim CE;Witte D;Sørgjerd EP;Brillon DJ;Pedersen O;Beck-Nielsen H;Grarup N;Pratley RE;Rickels MR;Vella A;Ovalle F;Melander O;Harris RI;Varvel S;Grill VER;Bone Mineral Density in Childhood Study;Hakonarson H;Froguel P;Lonsdale JT;Mauricio D;Schloot NC;Khunti K;Greenbaum CJ;Åsvold BO;Yderstræde KB;Pearson ER;Schwartz S;Voight BF;Hansen T;Tuomi T;Boehm BO;Groop L;Leslie RD;Grant SFA
通讯作者：
Grant SFA
影响因子：
16.2
作者：
Buse, John B.;Wexler, Deborah J.;Davies, Melanie J.
通讯作者：
Davies, Melanie J.
影响因子：
3
作者：
Agardh, CD;Cilio, CM;Lernmark, Å
通讯作者：
Lernmark, Å
影响因子：
16.2
作者：
Dandona, Paresh;Mathieu, Chantal;Langkilde, Anna Maria
通讯作者：
Langkilde, Anna Maria
影响因子：
7.7
作者：
Cervin, Camilla;Lyssenko, Valeriya;Groop, Leif
通讯作者：
Groop, Leif