Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China.
Diabetes Metab Res Rev. 2015 May;31(4):411-20. doi: 10.1002/dmrr.2626. Epub 2015 Jan 23.
This study aimed to assess the associations between clinical characteristics and chronic complications in latent autoimmune diabetes in adults (LADA) and type 2 diabetes.
This is a retrospective study. Our diabetes registry included 6975 patients aged 30-75 years old with phenotypic type 2 diabetes who underwent islet autoantibody screening between 2003 and 2012; 384 patients were identified to have LADA. Rates of chronic complications for LADA and type 2 diabetes were compared using a 1 : 2 matched design. Logistic models were fitted to identify the presence of chronic diabetic complications using clinical characteristics including gender, age, duration of diabetes, glycemic control and metabolic syndrome.
When duration of diabetes is <5 years, the prevalence of diabetic nephropathy (nephropathy; 12.2% versus 21.8%, p = 0.018) and diabetic retinopathy (retinopathy; 8.1% versus 15.9%, p = 0.011) were significantly lower in patients with LADA than in patients with type 2 diabetes; the prevalence of nephropathy and retinopathy were comparable between both groups when duration is ≥5 years. There was no significant difference in the prevalence of macrovascular complications between groups. The areas under the receiver operating characteristic curves based on the nephropathy and retinopathy models were larger for LADA than for type 2 diabetes (0.72 versus 0.61, p = 0.013; 0.76 versus 0.68, p = 0.056).
Patients with LADA had a lower prevalence of microvascular complications than patients with type 2 diabetes when the duration of diabetes was <5 years. Regression equation fitted by clinical characteristics can better predict the risk of microvascular complications in LADA than in type 2 diabetes.
本研究旨在评估成人隐匿性自身免疫性糖尿病（LADA）和 2 型糖尿病患者的临床特征与慢性并发症之间的关联。
这是一项回顾性研究。我们的糖尿病登记处包括 6975 名年龄在 30-75 岁之间的表型 2 型糖尿病患者，他们在 2003 年至 2012 年间接受了胰岛自身抗体筛查；其中 384 名患者被诊断为 LADA。使用 1：2 匹配设计比较 LADA 和 2 型糖尿病的慢性并发症发生率。使用包括性别、年龄、糖尿病病程、血糖控制和代谢综合征在内的临床特征，通过逻辑模型来确定慢性糖尿病并发症的存在。
当糖尿病病程<5 年时，LADA 患者的糖尿病肾病（肾病；12.2%比 21.8%，p=0.018）和糖尿病视网膜病变（视网膜病变；8.1%比 15.9%，p=0.011）的患病率明显低于 2 型糖尿病患者；当病程≥5 年时，两组患者的肾病和视网膜病变患病率相当。两组之间大血管并发症的患病率没有显著差异。基于肾病和视网膜病变模型的受试者工作特征曲线下面积（AUC），LADA 大于 2 型糖尿病（0.72 比 0.61，p=0.013；0.76 比 0.68，p=0.056）。
当糖尿病病程<5 年时，LADA 患者的微血管并发症患病率低于 2 型糖尿病患者。由临床特征拟合的回归方程能更好地预测 LADA 患者微血管并发症的风险，优于 2 型糖尿病患者。
