Rosário Pedro Weslley S, Reis Janice Sepulveda, Fagundes Tiago Alvarenga, Calsolari Maria Regina, Amim Ricardo, Silva Saulo Cavalcanti, Purisch Saulo
Endocrinology Service, Santa Casa de Belo Horizonte, MG.
Arq Bras Endocrinol Metabol. 2007 Feb;51(1):52-8. doi: 10.1590/s0004-27302007000100009.
To determine the clinical and laboratory parameters and the progression to insulin requirement in two groups of LADA patients separated according to GADA titers, and to evaluate the benefit of early insulinization in patients at high risk of premature beta-cell failure (high GADA titers).
Among the diabetic adults seen at our service and screened for GADA at diagnosis, 54 were diagnosed with LADA and classified as having low (> 1 U/ml and < 17.2 U/ml) or high (> 17.2 U/ml) GADA titers. Fifty-four patients with type 2 diabetes (GADA-) were selected for comparison. In addition, 24 patients who had GADA titers > 20 U/ml and who were not initially insulinized were compared to 16 patients who were insulinized at diagnosis.
Insulin resistance was higher in the GADA- group, followed by patients with low GADA titers. BMI and the frequency of arterial hypertension, elevated triglycerides and reduced HDL cholesterol were lower in the high GADA+ group, with no difference between the GADA- or low GADA+ groups. The high GADA+ group showed a greater reduction and lower levels of C-peptide and required insulin earlier during follow-up. Patients with GADA titers > 20 U/ml and insulinized early presented no significant variation in C-peptide levels, had better glycemic control and required a lower insulin dose than patients who were insulinized later.
We agree that patients with LADA should be differentiated on the basis of GADA titers and that patients with GADA titers > 20 U/ml benefit from early insulinization.
确定根据谷氨酸脱羧酶自身抗体（GADA）滴度分组的两组成人隐匿性自身免疫性糖尿病（LADA）患者的临床和实验室参数以及胰岛素需求进展情况，并评估早期胰岛素治疗对存在胰岛β细胞功能过早衰竭高风险（高GADA滴度）患者的益处。
在我们科室就诊并在诊断时筛查GADA的糖尿病成年患者中，54例被诊断为LADA，并根据GADA滴度分为低滴度组（>1 U/ml且<17.2 U/ml）或高滴度组（>17.2 U/ml）。选取54例2型糖尿病患者（GADA阴性）作为对照。此外，将24例GADA滴度>20 U/ml且最初未接受胰岛素治疗的患者与16例诊断时即接受胰岛素治疗的患者进行比较。
GADA阴性组的胰岛素抵抗更高，其次是GADA低滴度组。高GADA阳性组的体重指数以及动脉高血压、甘油三酯升高和高密度脂蛋白胆固醇降低的发生率较低，GADA阴性组和GADA低阳性组之间无差异。高GADA阳性组在随访期间C肽水平下降幅度更大且水平更低，并且更早需要胰岛素治疗。GADA滴度>20 U/ml且早期接受胰岛素治疗的患者C肽水平无显著变化，血糖控制更好，且所需胰岛素剂量低于较晚接受胰岛素治疗的患者。
我们认同应根据GADA滴度对LADA患者进行区分，且GADA滴度>20 U/ml的患者可从早期胰岛素治疗中获益。
