2011年至2020年期间西班牙阿斯图里亚斯地区2型糖尿病重新分类为1型糖尿病的情况。

Reclassification of type 2 diabetes to type 1 diabetes in Asturias (Spain) between 2011 and 2020.

作者信息

Rodríguez Escobedo Raúl, Lambert Carmen, Morales Sánchez Paula, Delgado Álvarez Elías, Menéndez Torre Edelmiro

机构信息

Servicio de Endocrinología y Nutrición. Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, España.

Grupo de investigación en Endocrinología, Diabetes y Obesidad (ENDO), Instituto de Investigación del Principado de Asturias (ISPA), Oviedo, Asturias, España.

出版信息

Diabetol Metab Syndr. 2023 May 3;15(1):90. doi: 10.1186/s13098-023-01069-y.

DOI:10.1186/s13098-023-01069-y

PMID:37138364

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10155490/

Abstract

BACKGROUND

Differentiating between type 1 diabetes (T1D) and type 2 diabetes (T2D) can be difficult in adults. The aim of this study was to determine the frequency of diagnostic reclassification from T2D to T1D, the characteristics of the patients and the impact on the management of the disease.

METHODS

Observational and descriptive study including patients diagnosed with T1D in Asturias (Spain) between 2011 and 2020 who had been considered as T2D for at least 12 months.

RESULTS

A total of 205 patients were included, representing 45.3% of those diagnosed with T1D over 30 years of age. Median time of evolution as T2D was 7,8 years. The age was 59.1 ± 12.9 years. BMI was > 25 kg/m in 46.8% of patients. HbA1c was 9.1 ± 2.1%, 77 ± 22 mmol/mol, and 56.5% were using insulin. Pancreatic antibodies were present in 95.5%, the most frequent being GAD, 82.6%. At 6 months, basal insulin use increased from 46.9 to 86.3%, and HbA1c decreased, 9.2 ± 2.0%vs7.7 ± 1.2%, 77 ± 22vs60 ± 13 mmol/mol; p < 0.0001.

CONCLUSIONS

Diagnosis as T2D in patients with T1D in adults is common. Age, BMI, insulin use and other clinical features are not definitely discriminatory. GAD is the antibody of choice in case of diagnostic suspect. Reclassification has important implications for metabolic control.

摘要

背景

在成人中区分1型糖尿病（T1D）和2型糖尿病（T2D）可能具有挑战性。本研究的目的是确定从T2D重新诊断为T1D的频率、患者特征以及对疾病管理的影响。

方法

一项观察性和描述性研究，纳入了2011年至2020年间在西班牙阿斯图里亚斯被诊断为T1D但曾被视为T2D至少12个月的患者。

结果

共纳入205例患者，占30岁以上被诊断为T1D患者的45.3%。T2D病程的中位数为7.8年。年龄为59.1±12.9岁。46.8%的患者体重指数（BMI）>25kg/m²。糖化血红蛋白（HbA1c）为9.1±2.1%（77±22mmol/mol），56.5%的患者使用胰岛素。95.5%的患者存在胰腺抗体，最常见的是谷氨酸脱羧酶抗体（GAD），占82.6%。6个月时，基础胰岛素使用率从46.9%增至86.3%，HbA1c降低，从9.2±2.0%降至7.7±1.2%（77±22降至60±13mmol/mol）；p<0.0001。