Reinehr T, Schober E, Wiegand S, Thon A, Holl R
Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Datteln, Germany.
Arch Dis Child. 2006 Jun;91(6):473-7. doi: 10.1136/adc.2005.088229. Epub 2006 Jan 31.
In adults, a fraction of diabetic individuals with beta-cell autoantibodies has initially non-insulin requiring diabetes clinically appearing as type 2 diabetes mellitus (T2DM), named latent autoimmune diabetes in adulthood (LADA). The occurrence of beta-cell autoantibodies in European children and adolescents with T2DM has not been reported so far.
The frequency of beta-cell autoantibodies (anti-GAD, anti-IA-2, and anti-ICA) was determined in 7050 diabetic children and adolescents. The type of diabetes was classified by paediatric diabetic specialists based on the clinical presentation. Children with non-insulin dependent T2DM over a one year period were studied separately.
A total of 6922 children were clinically classified as having type 1 diabetes (T1DM) and 128 children as having T2DM. Thirty six per cent of the children with T2DM had at least one detectable beta-cell autoantibody. These children did not differ significantly from the children with T2DM and without autoantibodies in respect of age, gender, weight status, lipids, blood pressure, C-peptide, glucose, and HbA1c at manifestation, as well as frequency of anti-thyroidal antibodies and insulin treatment during follow up. In the subgroup of the 38 children with T2DM without insulin requirement over a one year period, autoantibodies occurred in 32%. These 12 children were predominantly obese (67%), female (67%), and in the pubertal age range.
beta-cell autoantibodies were detectable in a subgroup of initially non-insulin dependent diabetic children and adolescents with the clinical appearance of T2DM. Following the terminology "latent autoimmune diabetes in adulthood (LADA)", this subgroup might be classified as "LADY" (latent autoimmune diabetes in youth).
在成人中，一部分伴有β细胞自身抗体的糖尿病患者最初临床上表现为2型糖尿病（T2DM），无需胰岛素治疗，称为成人隐匿性自身免疫性糖尿病（LADA）。目前尚无欧洲儿童和青少年T2DM患者中β细胞自身抗体发生情况的报道。
测定了7050例糖尿病儿童和青少年中β细胞自身抗体（抗谷氨酸脱羧酶抗体、抗胰岛细胞抗体2、抗胰岛细胞抗体）的频率。糖尿病类型由儿科糖尿病专家根据临床表现进行分类。对非胰岛素依赖型T2DM儿童进行了为期一年的单独研究。
共有6922例儿童临床诊断为1型糖尿病（T1DM），128例儿童诊断为T2DM。36%的T2DM儿童至少有一种可检测到的β细胞自身抗体。这些儿童在发病时的年龄、性别、体重状况、血脂、血压、C肽、血糖和糖化血红蛋白，以及随访期间抗甲状腺抗体的频率和胰岛素治疗方面与无自身抗体的T2DM儿童无显著差异。在38例为期一年无需胰岛素治疗的T2DM儿童亚组中，32%出现自身抗体。这12名儿童主要为肥胖（67%）、女性（67%），且处于青春期。
在最初表现为T2DM的非胰岛素依赖型糖尿病儿童和青少年亚组中可检测到β细胞自身抗体。按照“成人隐匿性自身免疫性糖尿病（LADA）”的术语，该亚组可能被归类为“LADY”（青少年隐匿性自身免疫性糖尿病）。
