Larger E, Dubois-Laforgue D, Timsit J
Service de Diabétologie, Hôpital Bichat, Paris.
Presse Med. 1999 Nov 6;28(34):1895-903.
Among the various diseases leading to chronic hyperglycemia, type 1 diabetes mellitus is distinctive by the presence of specific autoantibodies. The common from of type 1 diabetes mellitus is insulin-dependant diabetes, but type 1 diabetes may also present as non-insulin-dependent. In order to predict insulin-dependence and screen for associated autoimmune diseases, search for autoantibodies is required in all patients with diabetes, whatever the clinical presentation. COMPLEX PATHOPHYSIOLOGY: Diabetes mellitus is a multifactorial disease implicating of environmental and genetic factors leading to breakdown immune tolerance. LONG PRECLINICAL PHASE: Chronic hyperglycemia is preceded by a long preclinical phase during which the only observable anomalies result from activation of the immune system. With the development of simplified techniques for detecting autoantibodies, it would be reasonable to foresee large-scale screening. ONGOING SECONDARY PREVENTION TRIALS: The goal is to prevent the development of chronic hyperglycemia by intervening early, during the infraclinical phase, in patients with signs of immune activation. AT THE TIME OF DIAGNOSIS: When diabetes is discovered, intensive insulin therapy helps preserve residual insulin secretion and guarantees better long-term metabolic control.
在导致慢性高血糖的各种疾病中，1型糖尿病因存在特定自身抗体而具有独特性。1型糖尿病的常见形式是胰岛素依赖型糖尿病，但1型糖尿病也可能表现为非胰岛素依赖型。为了预测胰岛素依赖性并筛查相关自身免疫性疾病，所有糖尿病患者无论临床表现如何都需要检测自身抗体。复杂的病理生理学：糖尿病是一种涉及环境和遗传因素导致免疫耐受破坏的多因素疾病。漫长的临床前期：慢性高血糖之前有一个漫长的临床前期，在此期间唯一可观察到的异常是免疫系统激活的结果。随着检测自身抗体的简化技术的发展，预见大规模筛查是合理的。正在进行的二级预防试验：目标是通过在临床前期对有免疫激活迹象的患者进行早期干预来预防慢性高血糖的发展。在诊断时：当发现糖尿病时，强化胰岛素治疗有助于保留残余胰岛素分泌并保证更好的长期代谢控制。
