Faculty of Medicine, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, 89081, Germany.
Pediatr Diabetes. 2013 Dec;14(8):562-74. doi: 10.1111/pedi.12043. Epub 2013 Apr 30.
To characterize the clinical and immunological features of HLA-typed youth with pediatric onset of type 2 diabetes mellitus (T2DM).
One hundred and seven patients with clinically diagnosed T2DM (aged ≤20 yr at diagnosis) were examined. DNA and serum, obtained after a median diabetes duration of 2.2 (Q1-Q3: 0.8-4.6) yr, were used for centralized HLA-typing and autoantibody (GADA, IA-2A, ZnT8A) measurements.
64.6% of patients were female and median age at diagnosis was 13.8 (Q1-Q3: 11.6-15.4) yr. Patients were obese [median body mass index-standard deviation score (BMI-SDS): 2.6 (2.0-3.1)], 88.0% had a family history of diabetes and 40.2% a migration background. Islet autoantibodies were detected in 16 (15.0%), among which 7 (6.5%) had multiple islet autoantibodies. Autoantibody positive patients had poorer metabolic control than autoantibody negative patients [glycosylated hemoglobin A1c (HbA1c): 8.1 (6.9-10.1) % vs. 6.6 (5.9-8.0) %; p = 0.033], while patients with HLA-DR genetic risk had higher BMI-SDS than those with HLA-DRXX [2.6 (2.4-3.7) vs. 2.4 (1.7-2.9); p = 0.007]. Metabolic syndrome (61.7%), microalbuminuria (13.4%), and retinopathy (3.9%) were diagnosed. Therapies used were lifestyle only (35.5%), oral anti-diabetics (OAD) only (43.3 %), insulin + OAD (15.9%) and insulin only (5.6%). Patients with β-cell autoimmunity or HLA-DR genetic risk more frequently used insulin than confirmed T2DM patients (50.0 vs. 22.0%; p = 0.037) and less often had diabetic relatives (61.1 vs. 86.0%; p = 0.030).
T2DM was confirmed in about 90% of patients while about 10% with β-cell autoimmunity or HLA-DR genetic risk likely had either T1.5DM or 'double diabetes' or an unknown diabetes type.
描述 HLA 分型的儿科起病 2 型糖尿病（T2DM）青年患者的临床和免疫学特征。
对 107 例临床诊断为 T2DM 的患者（诊断时年龄≤20 岁）进行检查。在中位糖尿病病程为 2.2 年（Q1-Q3：0.8-4.6 年）后，获得 DNA 和血清，用于集中 HLA 分型和自身抗体（GADA、IA-2A、ZnT8A）测量。
64.6%的患者为女性，诊断时的中位年龄为 13.8 岁（Q1-Q3：11.6-15.4 岁）。患者肥胖[中位体质指数标准差评分（BMI-SDS）：2.6（2.0-3.1）]，88.0%有糖尿病家族史，40.2%有移民背景。16 例（15.0%）检测到胰岛自身抗体，其中 7 例（6.5%）有多种胰岛自身抗体。自身抗体阳性患者的代谢控制较自身抗体阴性患者差[糖化血红蛋白 A1c（HbA1c）：8.1%（6.9-10.1%）比 6.6%（5.9-8.0%）；p=0.033]，而具有 HLA-DR 遗传风险的患者 BMI-SDS 高于 HLA-DRXX 患者[2.6（2.4-3.7）比 2.4（1.7-2.9）；p=0.007]。诊断出代谢综合征（61.7%）、微量白蛋白尿（13.4%）和视网膜病变（3.9%）。使用的治疗方法有仅生活方式治疗（35.5%）、仅口服降糖药（OAD）（43.3%）、胰岛素+OAD（15.9%）和仅胰岛素（5.6%）。有β细胞自身免疫或 HLA-DR 遗传风险的患者比确诊的 T2DM 患者更常使用胰岛素（50.0%比 22.0%；p=0.037），且有糖尿病亲属的比例较低（61.1%比 86.0%；p=0.030）。
约 90%的患者被确诊为 T2DM，而约 10%有β细胞自身免疫或 HLA-DR 遗传风险的患者可能患有 T1.5DM 或“双重糖尿病”或未知类型的糖尿病。
