Adeleye Olufunmilayo O, Ogbera Anthonia O, Fasanmade Olufemi, Ogunleye Olayinka O, Dada Akinola O, Ale Ayotunde O, Abatan Femi M
Department of Medicine, Lagos State University Teaching Hospital, 1-5 Oba Akinjobi Way, Ikeja, Lagos, Nigeria.
Int Arch Med. 2012 Aug 15;5(1):23. doi: 10.1186/1755-7682-5-23.
Latent autoimmune diabetes in adults (LADA) is an entity characterized by the presence of GAD autoantibodies. LADA is largely understudied and underreported amongst Nigerians with Diabetes Mellitus (DM). We undertook to document the Prevalence, clinical and biochemical characteristics of LADA in a subset of Nigerians who hitherto had been treated for type 2 DM.
This is a cross-sectional study conducted on 235 patients being managed for type 2 DM. The diagnosis of LADA was made in the presence of Glutamic Acid Decarboxylase autoantibody (GADA) positivity in the study subjects. Thereafter persons with LADA were compared with those without LADA. Clinical parameters such as demographic data, history of diabetes mellitus (DM) and its complications were obtained, biochemical parameters including Fasting blood glucose (FBG), C-peptide, glycated haemoglobin (HbA1c) and lipid parameters were compared in both groups of Study subject. Test statistics used were Student t- test and χ 2. SPSS was used for data analysis.
Thirty three out of 235 of the Study subjects were GADA positive, giving a prevalence of 14%. The mean age (SD) of the subjects with LADA is 53.24(7.22) with an age range of 30-63 years. Majority (48%) of LADA subjects were in the 50-59 age category. There was no significant difference in the proportion of males and females with LADA (p = 0.3). 37% of patients with LADA were on insulin for glycaemic control. Three (3) LADA subjects had history/clinical evidence of autoimmune thyroid disease. 66% of LADA were in the overweight/obese category. LADA subjects had significant poor long term glycaemic control compared with anti-GAD negative subjects (p = 0.026). About half of LADA subjects were insulinopaenic. LADA subjects had lower levels of total cholesterol than GADA-ve subjects (p = 0.03). A higher proportion of LADA had evidence of microvascular complications of DM compared with antiGAD negative individuals.
The diagnosis of LADA should be entertained in overweight/obese persons from the fourth decade of life presenting with DM. Pharmacotherapy with insulin is a potential means of managing hyperglycaemia in this group of patients especially since a significant proportion are insulinopaenic. The Prevalence of LADA in our patients is comparable to what obtains in Ghanaian and Caucasian populations.
成人隐匿性自身免疫性糖尿病（LADA）是一种以存在谷氨酸脱羧酶自身抗体为特征的疾病。在尼日利亚糖尿病（DM）患者中，LADA在很大程度上未得到充分研究和报道。我们致力于记录一组此前接受过2型糖尿病治疗的尼日利亚人中LADA的患病率、临床和生化特征。
这是一项对235例接受2型糖尿病治疗的患者进行的横断面研究。在研究对象中，若谷氨酸脱羧酶自身抗体（GADA）呈阳性，则诊断为LADA。此后，将LADA患者与非LADA患者进行比较。获取临床参数，如人口统计学数据、糖尿病（DM）病史及其并发症，比较两组研究对象的生化参数，包括空腹血糖（FBG）、C肽、糖化血红蛋白（HbA1c）和血脂参数。使用的检验统计量为Student t检验和χ²检验。采用SPSS进行数据分析。
235例研究对象中有33例GADA呈阳性，患病率为14%。LADA患者的平均年龄（标准差）为53.24（7.22）岁，年龄范围为30 - 63岁。大多数（48%）LADA患者年龄在50 - 59岁之间。LADA患者中男性和女性的比例无显著差异（p = 0.3）。37%的LADA患者使用胰岛素进行血糖控制。3例LADA患者有自身免疫性甲状腺疾病的病史/临床证据。66%的LADA患者属于超重/肥胖类别。与抗GAD阴性患者相比，LADA患者的长期血糖控制明显较差（p = 0.026）。约一半的LADA患者存在胰岛素分泌不足。LADA患者的总胆固醇水平低于GADA阴性患者（p = 0.03）。与抗GAD阴性个体相比，LADA患者中糖尿病微血管并发症的证据比例更高。
对于40岁及以上出现糖尿病的超重/肥胖人群，应考虑LADA的诊断。胰岛素药物治疗是管理这类患者高血糖的一种潜在方法，特别是因为相当一部分患者存在胰岛素分泌不足。我们患者中LADA的患病率与加纳人和白种人群相当。
