Dhanwal D K, Agarwal S, Garg S, Agarwal P
Department of Medicine, Maulana Azad Medical College, New Delhi, India.
Indian J Med Res. 2014 Sep;140(3):356-60.
BACKGROUND & OBJECTIVES: There has been a rise in the incidence of diabetes mellitus in the younger population of India. There are limited data available on the immunological profile of youth onset diabetes mellitus (DM) especially in type 2. Therefore, this study was undertaken to evaluate the clinical and immunological profile of youth onset DM in north India.
Fifty one consecutive patients of 8-35 yr of age with diabetes mellitus attending the Lok Nayak Hospital, Maulana Azad Medical College, New Delhi, and Hormone Care and Research Center at Ghaziabad, Uttar Pradesh, India, were included in the study. All subjects were tested for glutamic acid decarboxylase (GAD), an islet cell antigen ICA512/IA2, and insulin antibodies. GAD and ICA512/IA2 were done by ELISA and insulin autoantibodies were tested by radioimmunoassay (RIA) method. These patients were also screened for hepatitis A to E, cytomegalovirus (CMV) and Epstein-Barr virus (EBV) as trigger factors for onset of type 1 DM.
o0 f the total 51 patients, 38 were men and 13 were women. The mean age and BMI of the subjects was 19.7 (±7) years and 21 (± 5) kg/m [2] , respectively. Twenty patients were below the age of 18 yr and their height was more than 75 th percentile of Indian standards. All patients were symptomatic and 12 of these presented with ketoacidosis. Only 48 per cent (n=24) were positive for GAD, 14 per cent (n=7) for ICA512/IA-2, and 28% (n=14) were positive for insulin antibody. Five of these patients had evidence of hepatitis E virus infection. None of the subjects had evidence of active CMV or EBV infection.
INTERPRETATION & CONCLUSIONS: About half of the youth onset diabetes mellitus patients from north India had presence of pancreatic autoimmunity in the form of GAD, ICA512/IA2, and insulin antibodies or a combination of antibodies suggestive of having type 1 DM. Further studies need to be done on a large sample size in different parts of the country.
印度年轻人群中糖尿病的发病率呈上升趋势。关于青年发病型糖尿病（DM），尤其是2型糖尿病的免疫学特征的数据有限。因此，本研究旨在评估印度北部青年发病型糖尿病的临床和免疫学特征。
连续纳入51例年龄在8至35岁之间、患有糖尿病的患者，这些患者来自印度新德里的莫拉纳·阿扎德医学院洛卡·纳亚克医院以及印度北方邦加济阿巴德的激素护理与研究中心。所有受试者均检测了谷氨酸脱羧酶（GAD）、胰岛细胞抗原ICA512/IA2和胰岛素抗体。GAD和ICA512/IA2采用酶联免疫吸附测定（ELISA）法检测，胰岛素自身抗体采用放射免疫测定（RIA）法检测。还对这些患者进行了甲型至戊型肝炎病毒、巨细胞病毒（CMV）和爱泼斯坦-巴尔病毒（EBV）筛查，以寻找1型糖尿病发病的触发因素。
51例患者中，男性38例，女性13例。受试者的平均年龄和体重指数分别为19.7（±7）岁和21（±5）kg/m²。20例患者年龄低于18岁，其身高超过印度标准的第75百分位数。所有患者均有症状，其中12例出现酮症酸中毒。仅48%（n = 24）的患者GAD呈阳性，14%（n = 7）的患者ICA512/IA - 2呈阳性，28%（n = 14）的患者胰岛素抗体呈阳性。其中5例患者有戊型肝炎病毒感染证据。所有受试者均无活动性CMV或EBV感染证据。
来自印度北部的约一半青年发病型糖尿病患者存在以GAD、ICA512/IA2和胰岛素抗体形式存在的胰腺自身免疫，或存在提示患有1型糖尿病的抗体组合。需要在该国不同地区对大样本进行进一步研究。
