Department of Clinical Sciences, Lund University, Malmö, Sweden.
Diabetologia. 2013 Feb;56(2):252-8. doi: 10.1007/s00125-012-2759-y. Epub 2012 Oct 25.
AIMS/HYPOTHESIS: Our aim was to study whether glycaemic control differs between individuals with latent autoimmune diabetes in adults (LADA) and patients with type 2 diabetes, and whether it is influenced by time on insulin therapy.
We performed a retrospective study of 372 patients with LADA (205 men and 167 women; median age 54 years, range 35-80 years) from Swedish cohorts from Skåne (n = 272) and Västerbotten (n = 100). Age- and sex-matched patients with type 2 diabetes were included as controls. Data on the use of oral hypoglycaemic agents (OHAs), insulin and insulin-OHA combination therapy was retrieved from the medical records. Poor glycaemic control was defined as HbA(1c) ≥7.0% (≥53 mmol/mol) at follow-up.
The individuals with LADA and with type 2 diabetes were followed for an average of 107 months. LADA patients were leaner than type 2 diabetes patients at diagnosis (BMI 27.7 vs 31.0 kg/m(2); p < 0.001) and follow-up (BMI 27.9 vs 30.2 kg/m(2); p < 0.001). Patients with LADA had been treated with insulin for longer than those with type 2 diabetes (53.3 vs 28.8 months; p < 0.001). There was no significant difference between the patient groups with regard to poor glycaemic control at diagnosis, but more patients with LADA (67.8%) than type 2 diabetes patients (53.0%; p < 0.001) had poor glycaemic control at follow-up. Patients with LADA had worse glycaemic control at follow-up compared with participants with type 2 diabetes (OR = 1.8, 95% CI 1.2, 2.7), adjusted for age at diagnosis, HbA(1c), BMI at diagnosis, follow-up time and duration of insulin treatment.
CONCLUSIONS/INTERPRETATION: Individuals with LADA have worse glycaemic control than patients with type 2 diabetes despite a longer time on insulin therapy.
目的/假设：我们的目的是研究成年人隐匿性自身免疫糖尿病（LADA）患者与 2 型糖尿病患者的血糖控制是否存在差异，以及这种差异是否受胰岛素治疗时间的影响。
我们对来自瑞典斯科讷（n=272）和韦斯特博滕（n=100）队列的 372 名 LADA 患者（205 名男性，167 名女性；中位年龄 54 岁，范围 35-80 岁）进行了回顾性研究。年龄和性别匹配的 2 型糖尿病患者作为对照。从病历中检索了口服降糖药（OHA）、胰岛素和胰岛素-OHA 联合治疗的数据。血糖控制不佳定义为随访时 HbA1c≥7.0%（≥53mmol/mol）。
LADA 患者和 2 型糖尿病患者的平均随访时间为 107 个月。LADA 患者在诊断时（BMI 27.7 与 31.0kg/m2；p<0.001）和随访时（BMI 27.9 与 30.2kg/m2；p<0.001）比 2 型糖尿病患者更瘦。LADA 患者接受胰岛素治疗的时间长于 2 型糖尿病患者（53.3 与 28.8 个月；p<0.001）。两组患者在诊断时的血糖控制不佳方面无显著差异，但 LADA 患者（67.8%）比 2 型糖尿病患者（53.0%）（p<0.001）在随访时血糖控制不佳的比例更高。与 2 型糖尿病患者相比，LADA 患者在随访时的血糖控制更差（OR=1.8，95%CI 1.2，2.7），校正诊断时年龄、HbA1c、诊断时 BMI、随访时间和胰岛素治疗时间。
结论/解释：尽管 LADA 患者接受胰岛素治疗的时间更长，但他们的血糖控制仍比 2 型糖尿病患者差。
