Piñero-Piloña A, Litonjua P, Aviles-Santa L, Raskin P
Department of Internal Medicine, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd., Dallas, TX 75390, USA.
Diabetes Care. 2001 Jun;24(6):1014-8. doi: 10.2337/diacare.24.6.1014.
To describe the clinical course of individuals with idiopathic type 1 diabetes after a mean of 5 years from diagnosis and to compare glycemic control between those treated with diet and/or oral agents and those treated with insulin at follow-up.
Medical records of patients with new-onset diabetes, who presented with unprovoked diabetic ketoacidosis, were reviewed. A total of 54 of these individuals were traceable and had relevant data collected within the past 2 years. All patients had nonsusceptibility HLA haplotypes and no serological evidence of autoimmune type 1 diabetes. Most of these patients were male (41 men and 13 women), were non-Caucasian, were obese at the time of diagnosis (BMI 31.6 +/- 6.3 kg/m(2)), reported weight loss (12.8 +/- 9.8 kg), had a family history of type 2 diabetes, and had acanthosis nigricans. At follow-up, 33 patients were still taking insulin and 21 were on diet and/or oral-agent therapy.
Both treatment groups were similar in clinical presentation and demographics at diagnosis. After 4.8 +/- 1.6 years of follow-up, the 33 patients that were receiving insulin had a lower HbA(1c) than the 21 patients who were using therapies other than insulin (7.8 +/- 2.4 vs. 11.1 +/- 3.5%, P = 0.009; 95% CI 1.0-6.5%). There was a high correlation between change in weight and change in HbA(1c) at follow-up (r = 0.45, P < 0.001, n = 54). There were no differences in the rate of diabetes complications or in the episodes of recurrent diabetic ketoacidosis.
Idiopathic type 1 diabetes occurs more frequently in male African-American patients but also occurs in other ethnic groups. Patients with idiopathic type 1 diabetes who continued to use insulin had better glycemic control than patients using therapies other than insulin. Regained weight is a good clinical marker for improvement in glycemic control. Individuals with this type of diabetes should not be switched to therapies other than insulin.
描述特发性1型糖尿病患者自诊断后平均5年的临床病程，并比较随访时接受饮食和/或口服药物治疗的患者与接受胰岛素治疗的患者之间的血糖控制情况。
回顾了新发糖尿病患者的病历，这些患者出现了自发性糖尿病酮症酸中毒。其中共有54例患者可追踪，并在过去2年内收集了相关数据。所有患者均具有非易感性HLA单倍型，且无自身免疫性1型糖尿病的血清学证据。这些患者大多数为男性（41名男性和13名女性），非白种人，诊断时肥胖（BMI 31.6±6.3kg/m²），报告有体重减轻（12.8±9.8kg），有2型糖尿病家族史，且有黑棘皮病。随访时，33例患者仍在使用胰岛素，21例接受饮食和/或口服药物治疗。
两个治疗组在诊断时的临床表现和人口统计学特征相似。经过4.8±1.6年的随访，接受胰岛素治疗的33例患者的糖化血红蛋白（HbA1c）低于使用胰岛素以外治疗方法的21例患者（7.8±2.4%对11.1±3.5%，P = 0.009；95%CI 1.0 - 6.5%）。随访时体重变化与HbA1c变化之间存在高度相关性（r = 0.45，P < 0.001，n = 54）。糖尿病并发症发生率或复发性糖尿病酮症酸中毒发作次数无差异。
特发性1型糖尿病在男性非裔美国患者中更常见，但也发生于其他种族群体。继续使用胰岛素的特发性1型糖尿病患者的血糖控制优于使用胰岛素以外治疗方法的患者。体重恢复是血糖控制改善的良好临床指标。患有这种类型糖尿病的个体不应改用胰岛素以外的治疗方法。
