Pancreatic duct hyperplasia/dysplasia in type 1 diabetes and pancreatic weight in individuals with and without diabetes. Reply to Kobayashi T, Aida K, Fukui T et al [letter] and Saisho Y [letter].
Pancreatic duct hyperplasia/dysplasia in type 1 diabetes and pancreatic weight in individuals with and without diabetes. Reply to Kobayashi T, Aida K, Fukui T et al [letter] and Saisho Y [letter].
复制标题
1 型糖尿病中的胰管增生/发育不良以及患有和不患有糖尿病的个体的胰腺重量。
DOI：
10.1007/s00125-016-3889-4
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发表时间：
2016
期刊：
影响因子：
8.2
通讯作者：
Atkinson,MarkA
中科院分区：
文献类型：
--
作者：
Campbell-Thompson,MarthaL;Schatz,DesmondA;Kaddis,JohnS;Atkinson,MarkA
To the Editor: We thank the Editor for providing the opportunity to respond to comments made in a letter by Dr Kobayashi et al [1] regarding our recent short communication noting that relative pancreas weight ratios (ratio of pancreas weight to body weight) allows for comparison between children and adults with type 1 diabetes [2]. Kobayashi et al conclude from their own studies that patients with slowly progressive diabetes have reduced pancreas weight compared with those with the more acute onset form. Unfortunately, we were unable to document such a difference since there is great difficulty in distinguishing subtypes so many years post diagnosis. It is clear that there is marked heterogeneity in type 1 diabetes, with age, geographical, genetic and environmental factors likely representing important contributors [3, 4]. What ‘slowly progressive diabetes’ represents outside the Japanese population remains the subject of debate. This subgroup had been given various names including ‘type 1.5 diabetes’,‘autoimmune diabetes in adults’ and ‘slow-onset diabetes in adults’ even before the latent autoimmune diabetes in adults (LADA) acronym was coined to describe autoantibody-positive patients who were initially diagnosed with type 2 diabetes [5].With this background of controversies and confusion with respect to diabetes classification terminologies, the natural question is one of how diabetes is defined in our investigational studies. In this work, patients are classified by a boardcertified endocrinologist (D. Schatz) based on chart records, as well as standard clinical (ADA) criteria and evaluation of laboratory studies including islet autoantibodies, HLA and C-peptide levels prior to histopathological studies [6]. Consistent with the field, no unified criteria are reported for LADA, although three factors are commonly considered: positivity for GAD autoantibodies (GADA), age> 35 years at onset and non-insulin therapy in the first 12 months after diagnosis [5]. Although Kobayashi et al reported that those identified as having LADA had significantly reduced pancreas weights compared with patients with acute type 1 diabetes (29.8±8.2 vs 42.1±7.3 g, respectively)[1], it would be of interest if the authors had compared the relative pancreas weights of their two subgroups with those of organ donors from the Network for Pancreatic Organ donors with Diabetes (nPOD) programme. This might have allowed for better comparisons between the two studies. From our own examination, four donors of Asian ethnicity exist in the nPOD biobank, of whom
