Zimmet P Z, Tuomi T, Mackay I R, Rowley M J, Knowles W, Cohen M, Lang D A
International Diabetes Institute, University Melbourne, Australia.
Diabet Med. 1994 Apr;11(3):299-303. doi: 10.1111/j.1464-5491.1994.tb00275.x.
Type 1 diabetes mellitus in adults may present in a manner similar to that of Type 2 diabetes but with a late development of insulin dependency. We studied 65 patients who presented with 'adult-onset' diabetes after the age of 30 years. Of these patients, 19 required insulin therapy. The insulin-treated patients were significantly younger, their onset of diabetes was at an earlier age, and their postprandial serum C-peptide levels were lower than those of the non-insulin-treated group. Moreover, the insulin-treated subjects had a higher mean concentration of antibodies to glutamic acid decarboxylase (GAD) (66.8 +/- 10.2 units) than the patients who did not require insulin (9.9 +/- 1.9 units) (p < 0.001) and their frequency of anti-GAD positivity was 73.7% versus 4.3% (p < 0.001). Thus, among patients attending a diabetes clinic, the majority (73.7%) of subjects who presented with diabetes after 30 years of age and who subsequently required therapy with insulin, actually have the islet cell lesion of Type 1 diabetes which progresses at a slower tempo than in children. We conclude that testing for anti-GAD in adult-onset non-obese diabetic patients should be a routine procedure in order to detect latent insulin-dependency at the earliest possible stage, since this assay can assist in the correct classification of diabetes, and more appropriate therapy.
成人1型糖尿病的表现方式可能与2型糖尿病相似，但胰岛素依赖出现较晚。我们研究了65例30岁以后出现“成人发病型”糖尿病的患者。其中，19例需要胰岛素治疗。接受胰岛素治疗的患者明显更年轻，糖尿病发病年龄更早，餐后血清C肽水平低于未接受胰岛素治疗的组。此外，接受胰岛素治疗的受试者谷氨酸脱羧酶（GAD）抗体的平均浓度（66.8±10.2单位）高于不需要胰岛素的患者（9.9±1.9单位）（p<0.001），其抗GAD阳性频率为73.7%，而后者为4.3%（p<0.001）。因此，在糖尿病门诊就诊的患者中，30岁以后出现糖尿病且随后需要胰岛素治疗的大多数受试者（73.7%）实际上患有1型糖尿病的胰岛细胞病变，其进展速度比儿童慢。我们得出结论，对成人发病的非肥胖糖尿病患者进行抗GAD检测应成为一项常规程序，以便尽早发现潜在的胰岛素依赖，因为该检测有助于糖尿病的正确分类和更恰当的治疗。
