Landin-Olsson Mona
Department of Diabetology and Endocrinology, University Hospital, S-221 85 Lund, Sweden.
Ann N Y Acad Sci. 2002 Apr;958:112-6. doi: 10.1111/j.1749-6632.2002.tb02953.x.
Latent autoimmune diabetes in adults (LADA) is a special form of diabetes that is clinically similar to type 2 diabetes but with positivity for pancreatic autoantibodies. The frequency of LADA patients among all patients diagnosed as type 2 varies between 6-50% in various populations. The frequency is higher in younger age groups. It is clear, however, that the frequency of autoimmune diabetes among adults is underestimated. Clinical features such as age and severity of symptoms are of no help in identifying these patients. Body mass index and C peptide levels in the general population increase with age, and these parameters are of limited use in identifying LADA patients. Determination of autoantibodies is necessary in order to correctly classify the type of diabetes. Among antibodies, GADA is the most frequently occurring autoantibody, followed by ICA. The natural course of these patients shows that C peptide will decrease with time in parallel with the curve for C peptide in classical type 1 diabetic patients. Most of the LADA patients will require insulin within three years. Our recommendation is that all patients be tested for pancreatic islet autoantibodies at diagnosis of diabetes to enable correct diagnosis and to avoid future failure of hypoglycemic agents and risk of complications due to hyperglycemia. It is still unclear whether early treatment with insulin is beneficial for the remaining beta cells.
成人隐匿性自身免疫性糖尿病（LADA）是一种特殊类型的糖尿病，临床上与2型糖尿病相似，但胰腺自身抗体呈阳性。在所有被诊断为2型糖尿病的患者中，LADA患者的比例在不同人群中为6%-50%不等。在较年轻的年龄组中，这一比例更高。然而，很明显，成人自身免疫性糖尿病的发病率被低估了。年龄和症状严重程度等临床特征无助于识别这些患者。一般人群中的体重指数和C肽水平随年龄增长而升高，这些参数在识别LADA患者方面作用有限。为了正确分类糖尿病类型，必须检测自身抗体。在各种抗体中，谷氨酸脱羧酶抗体（GADA）是最常见的自身抗体，其次是胰岛细胞抗体（ICA）。这些患者的自然病程表明，C肽水平会随着时间的推移而下降，与经典1型糖尿病患者的C肽曲线平行。大多数LADA患者在三年内将需要胰岛素治疗。我们建议所有糖尿病患者在诊断时都应检测胰岛自身抗体，以便正确诊断，并避免未来降糖药物治疗失败以及高血糖导致并发症的风险。胰岛素早期治疗对剩余的β细胞是否有益仍不清楚。
