Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
Joslin Diabetes Center, Harvard Medical School, Boston, MA, US.
Nat Rev Dis Primers. 2022 Sep 22;8(1):63. doi: 10.1038/s41572-022-00390-6.
Adult-onset autoimmune (AOA) diabetes pathophysiology starts with immune changes, followed by dysglycaemia and overt disease. AOA diabetes can occur as classic type 1 diabetes when associated with severe loss of insulin secretion. More frequently, it is diagnosed as latent autoimmune diabetes in adults, a slowly progressing form with late onset, a long period not requiring insulin, and it is often misdiagnosed as type 2 diabetes. As its clinical presentation varies remarkably and immune markers often lack specificity, it is challenging to classify each case ad hoc, especially when insulin treatment is not required at diagnosis. Proper care of AOA diabetes aims to prevent complications and to improve quality of life and life expectancy. To achieve these goals, attention should be paid to lifestyle factors, with the aid of pharmacological therapies properly tailored to each individual clinical setting. Given the heterogeneity of the disease, choosing the right therapy for AOA diabetes is challenging. Most of the trials testing disease-modifying therapies for autoimmune diabetes are conducted in people with childhood onset, whereas non-insulin diabetes therapies have mostly been studied in the larger population with type 2 diabetes. More randomized controlled trials of therapeutic agents in AOA diabetes are needed.
成人起病自身免疫性（AOA）糖尿病的病理生理学始于免疫改变，随后出现糖代谢异常和显性疾病。当与严重胰岛素分泌丧失相关时，AOA 糖尿病可表现为典型的 1 型糖尿病。更常见的是，它被诊断为成人隐匿性自身免疫性糖尿病，这是一种进展缓慢的形式，发病较晚，在很长一段时间内不需要胰岛素，并且经常被误诊为 2 型糖尿病。由于其临床表现差异显著，免疫标志物往往缺乏特异性，因此很难根据具体情况对每个病例进行分类，尤其是在诊断时不需要胰岛素治疗的情况下。AOA 糖尿病的适当治疗旨在预防并发症，提高生活质量和预期寿命。为了实现这些目标，应注意生活方式因素，并辅以适合个体临床情况的药物治疗。鉴于该疾病的异质性，选择 AOA 糖尿病的正确治疗方法具有挑战性。大多数针对自身免疫性糖尿病的疾病修饰疗法的临床试验都是在儿童发病的人群中进行的，而非胰岛素糖尿病的治疗方法主要在更大的 2 型糖尿病人群中进行了研究。需要更多的 AOA 糖尿病治疗药物的随机对照试验。
