Brophy S, Brunt H, Davies H, Mannan S, Williams R
University of Wales, Swansea, Swansea School of Medicine, Grove Building, Sigleton Park, Swansea, UK, SA2 8PP.
Cochrane Database Syst Rev. 2007 Jul 18(3):CD006165. doi: 10.1002/14651858.CD006165.pub2.
Latent autoimmune diabetes in Adults (LADA) is a slowly developing type 1 diabetes which presents as non-insulin dependent diabetes and progresses to insulin dependence. However, the best treatment strategy for LADA is unclear.
To compare interventions used for LADA.
Studies were obtained from searches of electronic databases (including MEDLINE, EMBASE), supplemented by hand searches, conference proceedings and consultation with experts.
Selection was in duplicate by two independent reviewers. RCT and controlled clinical trials evaluating interventions for LADA or type 2 diabetes with antibodies were included.
Two reviewers independently extracted data and assessed study quality. Studies were summarised in a descriptive manner.
Searches identified 8067 citations. Eight publications (seven studies) were included, involving 735 participants. All studies had high risk of bias. There were no data on use of metformin or glitazones alone. Rosiglitazone or sulphonylurea (SU) with insulin did not improve metabolic control significantly more than insulin alone. SU alone gave either poorer (one study, mean difference in HbA1c 2.8% (95% confidence interval (CI) 0.9 to 4.7) or equivalent metabolic control compared to insulin alone (two studies). There was evidence that SU caused earlier insulin dependence (insulin treated at two years: 60% (SU) and 5% (conventional care) (P < 0.001); classified insulin dependent: 64% (SU) and 12.5% (insulin group) (P = 0.007)). No interventions influenced fasting C-peptide, but insulin maintained stimulated C-peptide better than SU (one study, mean difference 7.7 ng/ml (95% CI 2.9 to 12.5) and insulin with rosiglitazone was superior to insulin alone (one study) at maintaining stimulated C-peptide. A pilot study showed better metabolic control at six months with subcutaneously administered glutamic acid decarboxylase (GAD) GAD65, a major autoantigen in autoimmune diabetes, compared to placebo. There was no information regarding quality of life, mortality, complications or costs in any of the publications. Time from diagnosis varied between recruitment at diagnosis to recruitment at nine years of disease duration and there was a great deal of variation in the selection criteria for LADA patients, making it difficult to generalise findings from these studies.
AUTHORS' CONCLUSIONS: There are few studies on this topic and existing studies have a high risk of bias. However, there does seem to be an indication that SU should not be a first line treatment for antibody positive type 2 diabetes. There is no significant evidence for or against other lines of treatment of LADA.
成人隐匿性自身免疫性糖尿病（LADA）是一种缓慢进展的1型糖尿病，表现为非胰岛素依赖型糖尿病，随后进展为胰岛素依赖型糖尿病。然而，LADA的最佳治疗策略尚不清楚。
比较用于LADA的干预措施。
通过检索电子数据库（包括MEDLINE、EMBASE）获取研究，并辅以手工检索、会议论文集和专家咨询。
由两名独立评审员进行重复筛选。纳入评估LADA或抗体阳性2型糖尿病干预措施的随机对照试验（RCT）和对照临床试验。
两名评审员独立提取数据并评估研究质量。以描述性方式总结研究。
检索到8067篇文献。纳入8篇出版物（7项研究），涉及735名参与者。所有研究均存在较高的偏倚风险。没有关于单独使用二甲双胍或格列酮的数据。罗格列酮或磺脲类药物（SU）联合胰岛素在改善代谢控制方面并不比单独使用胰岛素显著更好。单独使用SU与单独使用胰岛素相比，代谢控制要么更差（一项研究，糖化血红蛋白（HbA1c）平均差异为2.8%（95%置信区间（CI）0.9至4.7）），要么相当（两项研究）。有证据表明SU导致更早出现胰岛素依赖（两年时接受胰岛素治疗的比例：60%（SU组）和5%（传统治疗组）（P<0.001）；分类为胰岛素依赖的比例：64%（SU组）和12.5%（胰岛素组）（P = 0.007））。没有干预措施影响空腹C肽，但胰岛素在维持刺激后C肽方面优于SU（一项研究，平均差异7.7 ng/ml（95%CI 2.9至12.5）），并且胰岛素联合罗格列酮在维持刺激后C肽方面优于单独使用胰岛素（一项研究）。一项试点研究表明，与安慰剂相比，皮下注射谷氨酸脱羧酶（GAD）GAD65（自身免疫性糖尿病中的主要自身抗原）在6个月时能更好地控制代谢。在任何出版物中均未提及生活质量、死亡率、并发症或成本。从诊断到入组的时间从诊断时入组到疾病持续9年时入组不等，并且LADA患者的入选标准存在很大差异，这使得难以将这些研究结果进行推广。
关于该主题的研究较少，现有研究存在较高的偏倚风险。然而，似乎有迹象表明SU不应作为抗体阳性2型糖尿病的一线治疗药物。对于LADA的其他治疗方法，没有支持或反对的显著证据。
