Carlsson Sofia
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Front Physiol. 2019 Mar 26;10:320. doi: 10.3389/fphys.2019.00320. eCollection 2019.
As the heterogeneity of diabetes is becoming increasingly clear, opportunities arise for more accurate assessment of factors influencing disease onset, which may lead to more efficient primary prevention. LADA - latent autoimmune diabetes in adults - is a common, hybrid form of diabetes with features of both type 1 and type 2 diabetes. This review aims to summarize current knowledge on the pathophysiological and etiological overlap and differences between LADA and type 2 diabetes, discuss similarities between LADA and type 1 diabetes and point at future research needs. Studies conducted to date show a clear genetic overlap between LADA and type 1 diabetes with a high risk conferred by variants in the human leukocyte antigen (HLA) region. In contrast, data from the limited number of studies on lifestyle factors available indicate that LADA may share several environmental risk factors with type 2 diabetes including overweight, physical inactivity, alcohol consumption (protective) and smoking. These factors are known to influence insulin sensitivity, suggesting that insulin resistance, in addition to insulin deficiency due to autoimmune destruction of the beta cells, may play a key role in the pathogenesis of LADA. Moreover, this implies that onset of LADA, similar to type 2 diabetes, to some extent could be prevented or postponed by lifestyle modification such as weight reduction and increased physical activity. The preventive potential of LADA is an important topic to elucidate in future studies, preferably intervention studies.
随着糖尿病的异质性日益明显，出现了更准确评估影响疾病发病因素的机会，这可能会带来更有效的一级预防。成人隐匿性自身免疫性糖尿病（LADA）是一种常见的混合型糖尿病，兼具1型和2型糖尿病的特征。本综述旨在总结目前关于LADA与2型糖尿病在病理生理和病因方面的重叠与差异的知识，讨论LADA与1型糖尿病的相似之处，并指出未来的研究需求。迄今为止进行的研究表明，LADA与1型糖尿病之间存在明显的遗传重叠，人类白细胞抗原（HLA）区域的变异赋予了较高风险。相比之下，现有关于生活方式因素的有限研究数据表明，LADA可能与2型糖尿病共享一些环境风险因素，包括超重、身体活动不足、饮酒（有保护作用）和吸烟。已知这些因素会影响胰岛素敏感性，这表明除了β细胞因自身免疫破坏导致胰岛素缺乏外，胰岛素抵抗可能在LADA的发病机制中起关键作用。此外，这意味着与2型糖尿病类似，LADA的发病在一定程度上可以通过减重和增加身体活动等生活方式的改变来预防或推迟。LADA的预防潜力是未来研究（最好是干预研究）中需要阐明的一个重要课题。
