Latent autoimmune diabetes of the adult: current knowledge and uncertainty.
Latent autoimmune diabetes of the adult: current knowledge and uncertainty.
复制标题
DOI：
10.1111/dme.12700
复制
发表时间：
2015-07
期刊：
影响因子：
--
通讯作者：
Danish Diabetes Academy Workshop and Workshop Speakers
中科院分区：
文献类型：
--
作者：
Laugesen E;Østergaard JA;Leslie RD;Danish Diabetes Academy Workshop and Workshop Speakers
与儿童期发病的1型糖尿病患者相比，成人期发病的自身免疫性糖尿病患者具有较少的人类白细胞抗原（HLA）相关遗传风险和较少的糖尿病相关自身抗体。诊断时的代谢变化反映了广泛的临床表型，从糖尿病酮症酸中毒到轻度非胰岛素需要型糖尿病，也称为成人隐匿性自身免疫性糖尿病（LADA）。后一种表型是成人发病的自身免疫性糖尿病的最普遍形式，并且可能是一般自身免疫性糖尿病的最普遍形式。虽然LADA与儿童期发病的1型糖尿病具有相同的遗传和免疫学特征，但它也与2型糖尿病具有某些遗传特征，这就提出了遗传异质性诱发这种疾病的问题。筛查成人发病糖尿病患者的糖尿病相关自身抗体以识别LADA患者的潜在价值强调了他们缺乏临床上独特的特征，与2型糖尿病相比他们不同的自然病史以及他们对专门管理策略的潜在需求。事实上，在一些研究中，LADA患者的血糖控制比2型糖尿病患者差，这突出了进一步治疗研究的必要性。在丹麦糖尿病学会安排的2014年研讨会上，讨论了旱地退化评估的分类、流行病学、遗传学、代谢、免疫学、临床表现和治疗方面的挑战。介绍和讨论总结在这篇综述中，其中列出了目前的想法和争议，围绕这种形式的糖尿病。 成人隐匿性自身免疫性糖尿病（LADA）是一种自身免疫性糖尿病，定义为成人发病，存在糖尿病相关自身抗体，并且在诊断后一段时间内不需要胰岛素治疗。 免疫学上，谷氨酸脱羧酶65自身抗体是迄今为止成人发病糖尿病中最常见的自身抗体。 LADA是成人发病的自身免疫性糖尿病的最普遍形式，并且可能是一般自身免疫性糖尿病的最普遍形式。 LADA与1型和2型糖尿病都有遗传特征。 从表型上看，LADA患者经常被误诊为2型糖尿病。 LADA患者的HbA1c水平通常比2型糖尿病患者差。 在临床上，LADA患者往往有较低的平均年龄在糖尿病发病，较低的体重指数和更频繁的胰岛素治疗需要比2型糖尿病患者。 LADA的管理可能需要专门的策略，但目前缺乏随机对照试验数据。
Patients with adult-onset autoimmune diabetes have less Human Leucocyte Antigen (HLA)-associated genetic risk and fewer diabetes-associated autoantibodies compared with patients with childhood-onset Type 1 diabetes. Metabolic changes at diagnosis reflect a broad clinical phenotype ranging from diabetic ketoacidosis to mild non-insulin-requiring diabetes, also known as latent autoimmune diabetes of the adult (LADA). This latter phenotype is the most prevalent form of adult-onset autoimmune diabetes and probably the most prevalent form of autoimmune diabetes in general. Although LADA is associated with the same genetic and immunological features as childhood-onset Type 1 diabetes, it also shares some genetic features with Type 2 diabetes, which raises the question of genetic heterogeneity predisposing to this form of the disease. The potential value of screening patients with adult-onset diabetes for diabetes-associated autoantibodies to identify those with LADA is emphasized by their lack of clinically distinct features, their different natural history compared with Type 2 diabetes and their potential need for a dedicated management strategy. The fact that, in some studies, patients with LADA show worse glucose control than patients with Type 2 diabetes, highlights the need for further therapeutic studies. Challenges regarding classification, epidemiology, genetics, metabolism, immunology, clinical presentation and treatment of LADA were discussed at a 2014 workshop arranged by the Danish Diabetes Academy. The presentations and discussions are summarized in this review, which sets out the current ideas and controversies surrounding this form of diabetes. Latent autoimmune diabetes of the adult (LADA) is an autoimmune diabetes defined by adult-onset, presence of diabetes associated autoantibodies, and no insulin treatment requirement for a period after diagnosis. Immunologically, glutamic acid decarboxylase 65 autoantibodies are by far the most common autoantibody in adult-onset diabetes. LADA is the most prevalent form of adult-onset autoimmune diabetes and probably the most prevalent form of autoimmune diabetes in general. LADA shares genetic features with both type 1 and type 2 diabetes. Phenotypically, LADA patients are often misdiagnosed as having type 2 diabetes. LADA patients generally have worse HbA1c levels than type 2 diabetes patients. Clinically, LADA patients tend to have a lower mean age at diabetes onset, lower body mass index and more frequent need for insulin treatment than patients with type 2 diabetes. Management of LADA may require a dedicated strategy, yet currently there is a paucity of randomized controlled trial data.