Diabetes and Metabolism, Bristol Medical School, University of Bristol, Level 2, Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK.
Curr Diab Rep. 2019 Sep 10;19(10):99. doi: 10.1007/s11892-019-1219-1.
Progression rate from islet autoimmunity to clinical diabetes is unpredictable. In this review, we focus on an intriguing group of slow progressors who have high-risk islet autoantibody profiles but some remain diabetes free for decades.
Birth cohort studies show that islet autoimmunity presents early in life and approximately 70% of individuals with multiple islet autoantibodies develop clinical symptoms of diabetes within 10 years. Some "at risk" individuals however progress very slowly. Recent genetic studies confirm that approximately half of type 1 diabetes (T1D) is diagnosed in adulthood. This creates a conundrum; slow progressors cannot account for the number of cases diagnosed in the adult population. There is a large "gap" in our understanding of the pathogenesis of adult onset T1D and a need for longitudinal studies to determine whether there are "at risk" adults in the general population; some of whom are rapid and some slow adult progressors.
从胰岛自身免疫到临床糖尿病的进展速度是不可预测的。在这篇综述中，我们关注的是一组有趣的进展缓慢者，他们具有高风险的胰岛自身抗体谱，但有些人在几十年内仍然没有糖尿病。
出生队列研究表明，胰岛自身免疫在生命早期就出现了，大约 70%的具有多种胰岛自身抗体的个体在 10 年内会出现糖尿病的临床症状。然而，一些“高危”个体的进展非常缓慢。最近的遗传研究证实，大约一半的 1 型糖尿病（T1D）是在成年期诊断出来的。这就产生了一个难题；进展缓慢者不能解释在成年人群中诊断出的病例数。我们对成人发病的 T1D 的发病机制的理解还存在很大的“差距”，需要进行纵向研究来确定在一般人群中是否存在“高危”成年人；其中一些是快速的，而另一些则是缓慢的成年进展者。
