Department of Endocrinology and Diabetology, Lund University Hospital, Lund, Sweden.
Eur J Endocrinol. 2011 Feb;164(2):239-45. doi: 10.1530/EJE-10-0901. Epub 2010 Nov 18.
The optimal treatment of latent autoimmune diabetes in adults (LADA) is not established. We explored whether early insulin treatment, which has shown beneficial effects in rodents and in human pilot studies, would result in better preservation of β-cell function or metabolic control, compared with conventional treatment.
Glucagon-stimulated C-peptide and HbAlc were evaluated at baseline and after 12, 24 and 36 months in 37 patients recently diagnosed with diabetes, aged ≥ 30 years, non-insulin-requiring and GADAb and/or ICA positive. Twenty patients received early insulin and 17 received conventional treatment (diet ± oral hypoglycaemic agents (OHA), metformin, some and/or sulfonylurea) and insulin when necessary.
Level of metabolic control, HbAlc, was preserved in the early insulin treated, while it significantly deteriorated in the conventionally treated. There was no significant difference between the groups in C-peptide after 12, 24 or 36 months, or in the decline of C-peptide. Only baseline C-peptide predicted a C-peptide of ≥ 0.5 nmol/l at 36 months. Gender, body mass index, antibody titres or HbAlc did not influence the levels of C-peptide or HbAlc at baseline or end-of-study, or the decline in C-peptide. Among the diet ± OHA-treated, 5/17 (30%) developed insulin dependency during the follow-up. No major hypoglycaemic events occurred.
Early insulin treatment in LADA leads to better preservation of metabolic control and was safe. Superior preservation of C-peptide could not be significantly demonstrated. Only baseline level of C-peptide significantly influenced C-peptide level after 3 years. Further studies exploring the best treatment in LADA are warranted.
成人隐匿性自身免疫性糖尿病（LADA）的最佳治疗方法尚未确定。我们探讨了早期胰岛素治疗是否会比常规治疗更能改善β细胞功能或代谢控制，因为这种治疗方法在啮齿动物和人类初步研究中显示出了有益的效果。
对 37 名最近被诊断为年龄≥30 岁、无需胰岛素且 GADAb 和/或 ICA 阳性的糖尿病患者，在基线以及治疗 12、24 和 36 个月时，进行胰高血糖素刺激的 C 肽和 HbAlc 评估。20 名患者接受早期胰岛素治疗，17 名患者接受常规治疗（饮食+口服降糖药（OHA）、二甲双胍、某些和/或磺脲类药物），必要时给予胰岛素。
在早期胰岛素治疗组中，代谢控制水平（HbAlc）得到了维持，而在常规治疗组中则显著恶化。在 12、24 或 36 个月后，两组之间 C 肽没有显著差异，C 肽的下降也没有显著差异。只有基线 C 肽可以预测 36 个月时 C 肽≥0.5 nmol/l。性别、体重指数、抗体滴度或 HbAlc 均不影响基线或研究结束时的 C 肽或 HbAlc 水平，或 C 肽的下降。在饮食+OHA 治疗组中，有 17 名患者中的 5 名（30%）在随访期间出现了胰岛素依赖。没有发生严重的低血糖事件。
在 LADA 中进行早期胰岛素治疗可更好地维持代谢控制，且安全。未能显著证明 C 肽的保存更好。只有基线 C 肽水平显著影响 3 年后的 C 肽水平。需要进一步研究以探索 LADA 的最佳治疗方法。
