Clinical features of cases of seroconversion of anti-glutamic acid decarboxylase antibody during the clinical course of type 2 diabetes: a nationwide survey in Japan
Clinical features of cases of seroconversion of anti-glutamic acid decarboxylase antibody during the clinical course of type 2 diabetes: a nationwide survey in Japan
复制标题
2型糖尿病临床过程中抗谷氨酸脱羧酶抗体血清转化病例的临床特征：日本全国调查
DOI：
10.1007/s13340-017-0312-4
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发表时间：
2017
期刊：
影响因子：
2.2
通讯作者：
Kobayashi T
中科院分区：
文献类型：
--
作者：
Oikawa Y;Shimada A;Awata T;Fukui T;Ikegami H;Imagawa A;Kajio H;Kawabata Y;Kawasaki E;Miura J;Osawa H;Takahashi K;Tanaka S;Uchigata Y;Yasuda H;Yasuda K;Hanafusa T;Kobayashi T
1型糖尿病的发病机制不同于2型糖尿病，抗谷氨酸脱羧酶抗体（GADA）有助于诊断自身免疫性1型糖尿病。一些研究报道，GADA血清转换发生在2型糖尿病的临床过程中，导致“1型2型糖尿病”的发展。为了阐明GADA血清转换的临床特征和触发因素，我们对通过文献检索确定的临床病例进行了全国范围的问卷调查，并获得了38例病例的信息（24例接受胰岛素治疗，14例未接受胰岛素治疗）。糖尿病持续时间的GADA血清转换的确定是显着较长的胰岛素治疗组比没有it. This发现是特别注意到在胰岛素治疗的非肥胖患者血清C肽水平较低。在这些患者中，胰岛素治疗可能掩盖了血糖和HbA 1c水平的突然升高，可能导致GADA血清转换的延迟测定。在未接受胰岛素治疗的非肥胖患者中，在测定前即刻观察到血糖和HbA 1c水平突然升高，这一发现可能有助于预测GADA血清转换。根据目前的调查结果，我们无法确定GADA血清转换的明显触发因素。因此，医生可能需要考虑在2型糖尿病的治疗过程中并发1型糖尿病的可能性;当未接受胰岛素治疗的非肥胖2型糖尿病患者出现意外的突发高血糖症时，以及当接受胰岛素治疗的患者显示血清C肽水平较低时，应考虑GADA测量。
The pathogenesis of type 1 diabetes is different from that of type 2 diabetes, and anti-glutamic acid decarboxylase antibody (GADA) helps to diagnose autoimmune type 1 diabetes. Some studies reported that GADA seroconversion occurs during the clinical course of type 2 diabetes, leading to development of “type 1 on type 2 diabetes”. To clarify the clinical characteristics and triggers of GADA seroconversion, we performed a nationwide questionnaire survey for clinical cases identified by literature search, and obtained information on 38 cases (24 with insulin therapy and 14 without it). The diabetes duration up to determination of GADA seroconversion was significantly longer in the group with insulin therapy than that without it. This finding was particularly noted in insulin-treated non-obese patients with lower serum C-peptide levels. In these patients, insulin therapy could have masked sudden increases in plasma glucose and HbA1c levels, possibly leading to delayed determination of GADA seroconversion. In non-obese patients without insulin therapy, an abrupt rise in the plasma glucose and HbA1c levels was observed at immediately before the determination, a finding which may help to predict GADA seroconversion. From the results of the present survey, we could not determine apparent triggers of GADA seroconversion. Thus, physicians may need to consider the possibility of concurrent type 1 diabetes during the therapeutic course of type 2 diabetes; GADA measurement should be considered when non-obese type 2 diabetic patients not receiving insulin therapy experience unexpected abrupt hyperglycemia and when those receiving insulin therapy show low serum C-peptide levels.