Desailloud R, Fajardy I, Vambergue A, Prevost G, Pigny P, Fontaine P
Service d'Endocrinologie et de Diabétologie, Clinique Marc Linquette, Centre Hospitalier Régional et Universitaire de Lille.
Diabetes Metab. 2000 Nov;26(5):353-60.
Slow onset type 1 diabetes is an heterogeneous entity. Its clinical features may mimick type 2 diabetes but its pathophysiological mechanisms are close to type 1 diabetes.
To find out the frequencies, levels and associations of ICA, GADab and IA-2ab in type 2 diabetic patients with atypical phenotype. To compare it to type 1 diabetes.
ICA, GADab and IA-2ab were determined in: - 61 patients (age at diagnosis 48.2 +/- 10, range 36-73 years) with an initial diagnosis of type 2 diabetes but having at least one symptom suggesting a slow type 1 diabetes (loss of weight, absence of obesity at diagnosis or secondary failure of oral hypoglycaemic agents). - 70 patients with type 1 diabetes (age 18 +/- 8.9, range 2-35 years). Clinical data evaluated in slow type 1 were maximal BMI, BMI and loss of weight at diagnosis and autoimmune disease. Fasting C-peptide and insulinemia were also assessed.
(Slow type 1 diabetes versus type 1 diabetes). ICA (43% vs 70%; p <0.01) and IA-2ab (16% vs 75%; p <0.01) were more frequent in type 1. GADab were as frequent (62% vs 74%). Association of the three antibodies (15.7% vs 58.5%; p <0.05) were more frequent in type 1. Prevalence of GADab alone (27.5% vs 7.5%; p <0.05) was higher in slow type 1 diabetes and with higher levels (median 55.5 UI/ml vs 17 UI/ml; p <0.01). There was no difference for levels of ICA (25.5 UJDF/ml vs 28 UJDF/ml) or IA-2ab (11.5 UI/ml vs 38.5 UI/ml). BMI of GADab positive patients was lower. Delay of insulinotherapy was shorter in GADab or ICA positive patients. We did not find any relationship between antibodies presence and fasting C-peptide or insulinemia.
Slow type 1 diabetes should be evoked in atypical type 2 diabetes. Slow onset type 1 diabetic patients have different autoimmune patterns suggesting a different pathophysiological process. GADab and ICA are useful markers to predict future insulinopenia.
缓慢起病的1型糖尿病是一种异质性疾病。其临床特征可能类似2型糖尿病，但其病理生理机制更接近1型糖尿病。
了解非典型表型2型糖尿病患者中胰岛细胞抗体（ICA）、谷氨酸脱羧酶抗体（GADab）和胰岛抗原2抗体（IA - 2ab）的频率、水平及相关性。并与1型糖尿病进行比较。
检测以下对象的ICA、GADab和IA - 2ab： - 61例最初诊断为2型糖尿病，但至少有一项提示缓慢起病1型糖尿病症状（体重减轻、诊断时无肥胖或口服降糖药继发失效）的患者（诊断时年龄48.2±10岁，范围36 - 73岁）。 - 70例1型糖尿病患者（年龄18±
8.9岁，范围2 - 35岁）。评估缓慢起病1型糖尿病患者的临床数据包括最大体重指数（BMI）、诊断时的BMI及体重减轻情况和自身免疫性疾病。还评估空腹C肽和胰岛素水平。
（缓慢起病1型糖尿病与1型糖尿病比较）。ICA（43%对70%；p<0.01）和IA - 2ab（16%对75%；p<0.01）在1型糖尿病中更常见。GADab的出现频率相似（62%对74%）。三种抗体同时出现的情况（15.7%对58.5%；p<0.05）在1型糖尿病中更常见。单纯GADab的患病率（27.5%对7.5%；p<0.05）在缓慢起病1型糖尿病中更高，且水平更高（中位数55.5 UI/ml对17 UI/ml；p<0.01）。ICA（25.5 UJDF/ml对28 UJDF/ml）或IA - 2ab（11.5 UI/ml对38.5 UI/ml）的水平无差异。GADab阳性患者的BMI较低。GADab或ICA阳性患者开始胰岛素治疗的延迟时间较短。我们未发现抗体存在与空腹C肽或胰岛素水平之间有任何关系。
非典型2型糖尿病患者应考虑缓慢起病1型糖尿病。缓慢起病1型糖尿病患者有不同的自身免疫模式，提示不同病理生理过程。GADab和ICA是预测未来胰岛素缺乏的有用标志物。
