Juneja R, Palmer J P
Department of Veteran Affairs Puget Sound Health Care System, University of Washington, Endocrinology, Seattle 98108, USA.
Autoimmunity. 1999;29(1):65-83. doi: 10.3109/08916939908995974.
The disease process in classical Type 1 diabetes patients (IDDM) is believed to be autoimmune. In contrast, the disease process in classical Type 2 diabetes patients (NIDDM) is not autoimmune and a decreased sensitivity to insulin action is the main abnormality. The clinical distinction of Type 1 diabetes versus Type 2 diabetes is recognized to be imperfect and has limitations. There is a group of individuals (Type 1 1/2 diabetes), who present like typical NIDDM, but have some of the immunological and clinical features of IDDM. We review the current medical literature on Type 1 1/2 diabetes with special reference to its clinical characteristics, natural history and pathophysiology. Since the distinction between these two forms of diabetes may have important therapeutic implications especially with regards to the benefits of insulin therapy in patients with Type 1 1/2 diabetes and because of the need for uniformity in its diagnosis we recommend that both clinical plus biochemical criteria (the presence of ICA and/or GAD Ab, HLA typing and tests to quantify beta cell function) be used to make a diagnosis. Comparative studies in the area of cytokine production, T cell reactivity and autoantibody clustering between classic Type 1 diabetes and Type 1 1/2 diabetes patients are needed as are studies with the animal model of Type 1 1/2 diabetes, Psammomys obesus.
经典1型糖尿病患者（胰岛素依赖型糖尿病，IDDM）的疾病过程被认为是自身免疫性的。相比之下，经典2型糖尿病患者（非胰岛素依赖型糖尿病，NIDDM）的疾病过程不是自身免疫性的，对胰岛素作用的敏感性降低是主要异常。1型糖尿病与2型糖尿病的临床区分被认为并不完美且存在局限性。有一群个体（1.5型糖尿病），他们表现得像典型的NIDDM，但具有一些IDDM的免疫学和临床特征。我们回顾了当前关于1.5型糖尿病的医学文献，特别提及了其临床特征、自然病史和病理生理学。由于这两种糖尿病形式之间的区分可能具有重要的治疗意义，特别是对于1.5型糖尿病患者胰岛素治疗的益处，并且由于其诊断需要统一，我们建议使用临床和生化标准（胰岛细胞抗体和/或谷氨酸脱羧酶抗体的存在、HLA分型以及量化β细胞功能的测试）来进行诊断。需要对经典1型糖尿病和1.5型糖尿病患者在细胞因子产生、T细胞反应性和自身抗体聚集方面进行比较研究，也需要对1.5型糖尿病动物模型肥胖沙鼠进行研究。
