Experimental Medicine Department, Sapienza University of Rome, Rome, Italy.
Endocrinology and Diabetes Unit, Campus Bio-Medico University of Rome, Rome, Italy.
Diabet Med. 2021 Feb;38(2):e14455. doi: 10.1111/dme.14455. Epub 2020 Nov 23.
Microvascular complications' risk differs between people with latent autoimmune diabetes in adults (LADA) and people with type 2 diabetes. We aimed to investigate whether the prevalence of cardiac autonomic neuropathy, a life-threatening complication of diabetes, also varies depending on diabetes type.
In this cross-sectional study, 43 adults with LADA, 80 with type 1 diabetes and 61 with type 2 diabetes were screened for cardiac autonomic neuropathy with recommended tests. Logistic regression models were used to test differences between diabetes types adjusting for confounders.
Cardiac autonomic neuropathy was diagnosed in 17 (40%) participants with LADA, 21 (26%) participants with type 1 diabetes and 39 (64%) participants with type 2 diabetes (p < 0.001). The odds ratio (OR) for cardiac autonomic neuropathy in type 1 diabetes and in type 2 diabetes compared to LADA were 0.54 (95% CI: 0.25-1.20, p-value: 0.13) and 2.71 (95% CI: 1.21-6.06, p-value 0.015) respectively. Smoking ( OR 3.09, 95% CI: 1.40-6.82, p-value: 0.005), HDL cholesterol ( OR 0.29, 95% CI: 0.09-0.93, p-value: 0.037) and hypertension ( OR 2.11, 95% CI: 1.05-4.24, p-value: 0.037) were independent modifiable risk factors for cardiac autonomic neuropathy. Differences among diabetes types did not change after correction for confounders.
This is the first study offering a comparative evaluation of cardiac autonomic neuropathy among LADA, type 1 and type 2 diabetes, showing a lower risk of cardiac autonomic neuropathy in LADA compared to type 2 diabetes and similar compared to type 1 diabetes. This disparity was not due to differences in age, metabolic control or cardiovascular risk factors.
成人隐匿性自身免疫性糖尿病（LADA）患者与 2 型糖尿病患者的微血管并发症风险不同。我们旨在研究危及生命的糖尿病并发症——心脏自主神经病变的患病率是否也因糖尿病类型而异。
在这项横断面研究中，筛查了 43 名 LADA 成人、80 名 1 型糖尿病患者和 61 名 2 型糖尿病患者的心脏自主神经病变，使用推荐的测试方法。使用逻辑回归模型调整混杂因素后，检验不同糖尿病类型之间的差异。
LADA 组 17 名（40%）、1 型糖尿病组 21 名（26%）和 2 型糖尿病组 39 名（64%）患者被诊断为心脏自主神经病变（p<0.001）。与 LADA 相比，1 型糖尿病和 2 型糖尿病患者发生心脏自主神经病变的比值比（OR）分别为 0.54（95%CI：0.25-1.20，p 值：0.13）和 2.71（95%CI：1.21-6.06，p 值 0.015）。吸烟（OR 3.09，95%CI：1.40-6.82，p 值：0.005）、高密度脂蛋白胆固醇（OR 0.29，95%CI：0.09-0.93，p 值：0.037）和高血压（OR 2.11，95%CI：1.05-4.24，p 值：0.037）是心脏自主神经病变的独立可改变危险因素。校正混杂因素后，糖尿病类型之间的差异没有改变。
这是第一项比较 LADA、1 型和 2 型糖尿病患者心脏自主神经病变的研究，表明 LADA 患者发生心脏自主神经病变的风险低于 2 型糖尿病患者，与 1 型糖尿病患者相似。这种差异不是由于年龄、代谢控制或心血管危险因素的差异所致。
