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Alemán-Contreras R, Gómez-Díaz RA, Noyola-García ME, Mondragón-González R, Wacher N, Ferreira-Hermosillo A. Utility of Fasting C-Peptide for the Diagnostic Differentiation of Patients with Type 1, Type 2 Diabetes, MODY, and LADA. Life (Basel) 2024; 14:550. [PMID: 38792571 PMCID: PMC11122504 DOI: 10.3390/life14050550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/04/2024] [Accepted: 04/19/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The prevalence of obesity has increased in patients with type 1 diabetes (T1D) and latent autoimmune diabetes of the adult (LADA), limiting the use of clinical features such as the body mass index for its differentiation with type 2 diabetes (T2D). Additionally, some patients with maturity-onset diabetes of the young (MODY) or LADA are misdiagnosed as having T2D. The evaluation of autoantibodies and genetic testing are not fully available. We aimed to evaluate the utility of a widely available and less expensive diagnostic tool such as C-peptide to differentiate between T1D, T2D, MODY, and LADA. METHODS Our study included 38 patients with T1D, 49 with T2D, 13 with MODY, and 61 with LADA. We recorded anthropometric measurements, biochemical profiles, and antidiabetic treatment and determined C-peptide, anti-GAD65, and anti-IA2 antibodies. RESULTS C-peptide concentration differed significantly among populations (T1D: 0.2 ng/mL; T2D: 2.4 ng/mL; MODY: 1.14 ng/mL; LADA: 1.87 ng/mL). Through a ROC curve, we observed that the C-peptide cut-off point of 0.95 ng/mL allows differentiation between T1D and T2D (sensitivity 82%, specificity 77%); 0.82 ng/mL between T1D and LADA (sensitivity 82%, specificity 77%); and 1.65 ng/mL between T2D and MODY (sensitivity 72%, specificity 72%). CONCLUSIONS C-peptide is useful for the diagnostic differentiation of patients with type 1, type 2 diabetes, MODY, and LADA.
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Affiliation(s)
- Ricardo Alemán-Contreras
- Servicio de Medicina Interna, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico; (R.A.-C.); (M.E.N.-G.)
| | - Rita A. Gómez-Díaz
- Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico; (R.A.G.-D.); (R.M.-G.); (N.W.)
| | - Maura E. Noyola-García
- Servicio de Medicina Interna, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico; (R.A.-C.); (M.E.N.-G.)
| | - Rafael Mondragón-González
- Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico; (R.A.G.-D.); (R.M.-G.); (N.W.)
| | - Niels Wacher
- Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico; (R.A.G.-D.); (R.M.-G.); (N.W.)
| | - Aldo Ferreira-Hermosillo
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico
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Shaikh K, Mathew N. Latent Autoimmune Diabetes in Adults: A Case Report. Oman Med J 2024; 39:e596. [PMID: 38357433 PMCID: PMC10862229 DOI: 10.5001/omj.2024.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/29/2022] [Indexed: 02/16/2024] Open
Abstract
Latent autoimmune diabetes in adults (LADA) is a slow progressive autoimmune destruction of pancreatic beta cells. This condition tends to manifest during adulthood, often around 35 years of age. While LADA can initially be managed by oral medications, eventually the patient will require insulin. We report a case of a 34-year-old woman who was initially treated for type 2 diabetes mellitus but was later diagnosed with LADA.
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Affiliation(s)
- Khalid Shaikh
- Department of Medicine, Royal Oman Police Hospital, Muscat, Oman
| | - Natasha Mathew
- Department of Medicine, Royal Oman Police Hospital, Muscat, Oman
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Ravikumar V, Ahmed A, Anjankar A. A Review on Latent Autoimmune Diabetes in Adults. Cureus 2023; 15:e47915. [PMID: 38034250 PMCID: PMC10683931 DOI: 10.7759/cureus.47915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Latent autoimmune diabetes (LADA) is an unique form of diabetes that has characteristics of both type 1 and type 2 diabetes. Type 1.5 diabetes also known as LADA is occasionally confused for type 2 diabetes because there is delay in presenting features and early insulin independence. LADA, on the other hand, is an autoimmune disorder that differs from type 2 diabetes in that autoantibodies against pancreatic beta cells are what characterise it. Insulin production eventually diminishes due to the autoimmune destruction of pancreatic beta cells as a result of the pathophysiology of LADA. Autoantibodies to glutamic acid decarboxylase (GAD), islet antigen-2 (IA-2), and insulin are frequently detected in LADA patients. These autoantibodies have important implications for therapy strategies and are essential in differentiating LADA from type 2 diabetes. LADA clinical management is very challenging. The aim of this article is to view the characteristics, disease presentation, diagnostic challenges, progression and treatment modalities of LADA.
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Affiliation(s)
- Vijay Ravikumar
- Medical Education, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ariba Ahmed
- Medical Education, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ashish Anjankar
- Biochemistry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Umar AH, Ratnadewi D, Rafi M, Sulistyaningsih YC, Hamim H, Kusuma WA. Drug candidates and potential targets of Curculigo spp. compounds for treating diabetes mellitus based on network pharmacology, molecular docking and molecular dynamics simulation. J Biomol Struct Dyn 2023; 41:8544-8560. [PMID: 36300505 DOI: 10.1080/07391102.2022.2135597] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/08/2022] [Indexed: 10/31/2022]
Abstract
Curculigo spp. is a herb that is commonly used in Indonesia to treat diabetes mellitus (DM) . The main active components of Curculigo spp. were identified through our previous metabolomic study and online database platform. However, the biological mechanisms underlying Curculigo spp. activity in treating DM remain unclear. Therefore, in this study, a network pharmacology was used to explore the active compounds of Curculigo spp. and their potential molecular mechanisms for treating DM. Oral bioavailability and drug-likeness from the compounds of Curculigo spp. were screened using Lipinski's rule of five, BBB, HIA + and Caco-2 permeability criteria. A network of compound-target-disease-pathway was then constructed using Cytoscape. The highest degree compounds and targets were then confirmed by molecular docking and molecular dynamics (MD) simulations. The human body can absorb 33 compounds derived from Curculigo spp. In addition, 58 nodes and 62 edges generated a network analysis with the DM target. The highest degree of the compound-target-disease pathway was for orcinol glucoside, AKR1B1, autoimmune diabetes, bile acid and bile salt metabolism. Furthermore, the computational docking method on Curculigo spp. compounds with the highest degree revealed that orcinol glucoside interacted with PTPN1 through a hydrogen bond and resulted in a binding energy of -7.2 kcal mol-1. Through hydrogen bonds, orcinol glucoside in PTPN1 regulates multiple signaling pathways via the adherens junction pathway, which may play a therapeutic role in DM (type 2 diabetes: obesity). In addition, MD simulation confirmed that orcinol glucoside, is suitable for DM treatment by interacting with PTPN1.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Abdul Halim Umar
- Division of Pharmaceutical Biology, College of Pharmaceutical Sciences Makassar (Sekolah Tinggi Ilmu Farmasi Makassar), Makassar, Indonesia
| | - Diah Ratnadewi
- Department of Biology, Faculty of Mathematics and Natural Sciences, IPB University, Bogor, Indonesia
| | - Mohamad Rafi
- Department of Chemistry, Faculty of Mathematics and Natural Sciences, IPB University, Bogor, Indonesia
| | | | - Hamim Hamim
- Department of Biology, Faculty of Mathematics and Natural Sciences, IPB University, Bogor, Indonesia
| | - Wisnu Ananta Kusuma
- Department of Computer Science, Faculty of Mathematics and Natural Sciences, IPB University, Bogor, Indonesia
- Tropical Biopharmaca Research Center, IPB University, Bogor, Indonesia
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Min-ChunYeh, Chuang HC, Weng SF, Hsu CH, Huang CL, Lin YP, Lin YY, Hsieh YS. Newly diagnosed type 1 diabetes mellitus in a human immunodeficiency virus-infected patient with antiretroviral therapy-induced immune reconstitution inflammatory syndrome: a case report. BMC Infect Dis 2023; 23:619. [PMID: 37730544 PMCID: PMC10512543 DOI: 10.1186/s12879-023-08605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Diabetes that develops in human immunodeficiency virus (HIV)-infected patients who receive antiretroviral therapy (ART) is usually type 2 diabetes mellitus (T2DM); however, autoimmune diabetes, such as type 1 diabetes mellitus (T1DM) can also develop in this population. After treatment with ART, patients might experience clinical deterioration following an increase in the CD4 cell count, which is termed immune reconstitution inflammatory syndrome (IRIS). Here, we describe an HIV-infected patient on ART who developed T1DMat due to IRIS, highlighting the clinical complexity in diagnosis and treatment. CASE PRESENTATION A 36-year-old man infected with HIV had a nadir CD4 cell count of 15.53/μL before medication, which increased to 429.09/μL after 9 months of regular ART. The fasting serum glucose at 9 months was between 96 mg/dL and 117 mg/dL. After 11 months of ART, the patient was admitted to hospital for diabetic ketoacidosis (DKA) and Graves' disease (GD). Noninsulin antidiabetics (NIADs) were prescribed following the resolution of DKA. However, poor glycemic control was noted despite well-titrated NIADs. Further investigation demonstrated poor pancreatic beta cell function and elevated anti-glutamic acid decarboxylase (anti-GAD) and anti-tyrosine phosphatase-like insulinoma antigen 2 (anti-IA2) titers. According to the results, he was diagnosed with T1DM and received multiple daily injections(MDI) of insulin. The regimen of MDI was insulin degludec as basal insulin and insulin aspart as prandial insulin. After MDI therapy, his glycemic control was improved. CONCLUSION In this case, T1DM was ascribed to IRIS. Although this phenomenon has been demonstrated in previous case reports, further study is necessary to realize the mechanism of this association. Therefore, we emphasize that when HIV-infected patients on ART experience an unstable blood glucose level and abnormal thyroid function, physicians should consider T1DM and GD associated with ART-induced IRIS to reduce the subsequent complications and more serious endocrine dysfunction.
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Affiliation(s)
- Min-ChunYeh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Han-Chuan Chuang
- Division of Infection Diseases, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Shuen-Fu Weng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Chung-Huei Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Chen-Ling Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Yu-Pei Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Yan-Yu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Yu-Shan Hsieh
- School of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Mingde Rd., Beitou Dist, Taipei City, 112303 Taiwan
- Department of Research, Taipei Medical University Hospital, Taipei City, 11031 Taiwan
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Kacem FH, Jerbi A, Allymamod BT, Abed WB, Mnif M, Charfi N, Elleuch M, Rekik N, Masmoudi H, Abid M. Characteristics of adult-onset auto-immune type 1 diabetes. Am J Med Sci 2023; 366:49-56. [PMID: 37088301 DOI: 10.1016/j.amjms.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/20/2022] [Accepted: 04/11/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Classically described as a disease of childhood and adolescence, diabetes mellitus type 1 (T1DM) can occur in adulthood. Adult-onset T1DM is poorly documented and is often misdiagnosed. This study aims to describe the epidemiological aspect of T1DM with adult-onset and detail its clinical, paraclinical, and therapeutic characteristics. MATERIALS AND METHODS A 9-year retrospective longitudinal study (2011-2019) was conducted including adult patients (age >20 years) with confirmed diabetes and at least one of the auto-antibodies (auto-Abs) to glutamic-acid-decarboxylase (GAD), to islet-tyrosine-phosphatase 2 (IA2) or islet-cell-antibodies (ICA) positive. RESULTS A total of 166 patients were included (sex-ratio M/F: 1.34; mean age: 28.6 years [20-56 years]). At the onset, 50.6% of patients presented with diabetic ketosis and 13.3% with diabetic ketoacidosis. Cardinal symptoms of diabetes were present in 30.7% of patients only at diagnosis, while the discovery was fortuitous in 5.4% of cases. 27.7% of patients developed an additional auto-immune disease mainly autoimmune thyroid disease. The risk of developing another AUTO-IMMUNE DISEASE was highest in females (p = 0.010) and increased with age (p = 0.011). GAD-Abs, IA2-Abs, and ICA were positive in 98.2%, 13.3%, and 17.4% of cases respectively. Only GAD-Abs were found positive in 73.1%. Upon diagnosis, 75.9% of patients were treated with insulin, while 24.1% of patients were initially put on oral anti-diabetic drugs before requiring insulin within an average of 7.42 months. CONCLUSIONS Adult-onset T1DM has a different clinical course (slower onset, less abrupt symptoms, more insidious presentation, and more prolonged progression to insulin) that has to be known. Misdiagnosis of adult-onset T1DM can have serious consequences.
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Affiliation(s)
- Faten Hadj Kacem
- Endocrinology Department, Hedi Chaker Hospital, University of Sfax, Tunisia
| | - Ameni Jerbi
- Immunology Department, Habib Bourguiba Hospital, University of Sfax, Tunisia.
| | | | - Wafa Bel Abed
- Endocrinology Department, Hedi Chaker Hospital, University of Sfax, Tunisia
| | - Mouna Mnif
- Endocrinology Department, Hedi Chaker Hospital, University of Sfax, Tunisia
| | - Nadia Charfi
- Endocrinology Department, Hedi Chaker Hospital, University of Sfax, Tunisia
| | - Mouna Elleuch
- Endocrinology Department, Hedi Chaker Hospital, University of Sfax, Tunisia
| | - Nabila Rekik
- Endocrinology Department, Hedi Chaker Hospital, University of Sfax, Tunisia
| | - Hatem Masmoudi
- Immunology Department, Habib Bourguiba Hospital, University of Sfax, Tunisia
| | - Mohamed Abid
- Endocrinology Department, Hedi Chaker Hospital, University of Sfax, Tunisia
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Connor BW, Smith SE, Kalus A. Exploring Immune Therapies in a Twin Case of Latent Autoimmune Diabetes in Adults and Generalized Granuloma Annulare. Clin Diabetes 2023; 41:583-586. [PMID: 37849513 PMCID: PMC10577501 DOI: 10.2337/cd22-0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Affiliation(s)
- Brian W. Connor
- University of Washington School of Medicine, Seattle, WA
- Department of Internal Medicine, Division of Dermatology, University of Washington, Seattle, WA
| | | | - Andrea Kalus
- University of Washington School of Medicine, Seattle, WA
- Department of Internal Medicine, Division of Dermatology, University of Washington, Seattle, WA
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Vich-Pérez P, Abánades-Herranz JC, Mora-Navarro G, Carrasco-Sayalero ÁM, Salinero-Fort MÁ, Sevilla-Machuca I, Sanz-Pascual M, Álvarez Hernández-Cañizares C, de Burgos-Lunar C. Development and validation of a clinical score for identifying patients with high risk of latent autoimmune adult diabetes (LADA): The LADA primary care-protocol study. PLoS One 2023; 18:e0281657. [PMID: 36758065 PMCID: PMC9910627 DOI: 10.1371/journal.pone.0281657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/24/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Latent autoimmune diabetes in adults (LADA) is a type of diabetes mellitus showing overlapping characteristics between type 1 Diabetes Mellitus and type 2 Diabetes Mellitus (T2DM), and autoimmunity against insulin-producing pancreatic cells. For its diagnosis, at least one type of anti-pancreatic islet antibody (GADAb is the most common) is required. Many authors recommend performing this measure in all newly diagnosed patients with DM, but it is not possible in Primary Health Care (PHC) due to its high cost. Currently, a relevant proportion of patients diagnosed as T2DM could be LADA. Confusing LADA with T2DM has clinical and safety implications, given its different therapeutic approach. The main objective of the study is to develop and validate a clinical score for identifying adult patients with DM at high risk of LADA in PHC. METHODS This is an observational, descriptive, cross-sectional study carried out in Primary Care Health Centers with a centralized laboratory. All people over 30 years of age diagnosed with diabetes within a minimum of 6 months and a maximum of 4 years before the start of the study will be recruited. Individuals will be recruited by consecutive sampling. The study variables will be obtained through clinical interviews, physical examinations, and electronic medical records. The following variables will be recorded: those related to Diabetes Mellitus, sociodemographic, anthropometric, lifestyle habits, laboratory parameters, presence of comorbidities, additional treatments, personal or family autoimmune disorders, self-perceived health status, Fourlanos criteria, and LADA diagnosis (as main variable) according to current criteria. DISCUSSION The study will provide an effective method for identifying patients at increased risk of LADA and, therefore, candidates for antibody testing. However, a slight participation bias is to be expected. Differences between participants and non-participants will be studied to quantify this potential bias.
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Affiliation(s)
- Pilar Vich-Pérez
- Internal Medicine Specialist, Member of the MADIABETES Research Group, Principal Investigator, Los Alpes Health Center, Madrid, Spain
- * E-mail:
| | | | | | | | - Miguel Ángel Salinero-Fort
- Head of the Knowledge Management Area of the Madrid Health Council, Scientific Director of the MADIABETES Research Group, Madrid, Spain
| | | | - Mar Sanz-Pascual
- Member of the MADIABETES Research Group, Aquitania Health Center, Madrid, Spain
| | | | - Carmen de Burgos-Lunar
- Member of the MADIABETES Research Group, Specialist in Epidemiology and Public Health, San Carlos Clinical Hospital, Madrid, Spain
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Chandran L, Singh S A, Vellapandian C. Diagnostic Dilemmas and Current Treatment Approaches in Latent Onset Autoimmune Diabetes in Adults: A Concise Review. Curr Diabetes Rev 2023; 19:1-9. [PMID: 35331118 DOI: 10.2174/1573399818666220324095918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 11/22/2022]
Abstract
Latent Onset Autoimmune Diabetes in Adults (LADA) is an autoimmune disorder between T1DM and T2DM and is often misdiagnosed as T2DM due to its late-onset. The disease is characterized by β-cell failure and slow progression to insulin dependence. Early diagnosis is significant in limiting disease progression. C-peptide levels and autoantibodies against β-cells are the most critical diagnostic biomarkers in LADA. The review aims to provide an overview of the biomarkers used to diagnose LADA, and the following treatment approaches. We have summarized LADA's pathophysiology and the autoantibodies involved in the condition, diagnostic approaches, and challenges. There are clear shortcomings concerning the feasibility of autoantibody testing. Finally, we have explored the treatment strategies involved in the management of LADA. In conclusion, the usual management includes treatment with metformin and the addition of low doses of insulin. Newer oral hypoglycaemic agents, such as GLP-1RA and DPP-4 inhibitors, have been brought into use. Since the disease is not entirely understood at the research level and in clinical practice, we hope to encourage further research in this field to assess its prevalence. Large randomized controlled trials are required to compare the efficacy of different available treatment options.
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Affiliation(s)
- Lakshmi Chandran
- Department of Pharmacy Practice, SRM Institute of Science and Technology (SRMIST) (Formerly SRM University), Kattankulathur, Chengalpattu District, Chennai - 603203, Tamilnadu, India
| | - Ankul Singh S
- Department of Pharmacology, SRM Institute of Science and Technology (SRMIST) (Formerly SRM University), Kattankulathur, Chengalpattu District, Chennai - 603203, Tamilnadu, India
| | - Chitra Vellapandian
- Department of Pharmacology, SRM Institute of Science and Technology (SRMIST) (Formerly SRM University), Kattankulathur, Chengalpattu District, Chennai - 603203, Tamilnadu, India
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Neupane SK, Jaishi PP, Koirala D, Kandel A, Neupane PK. Diagnostic camouflage: A case report on Latent autoimmune diabetics of adulthood. Ann Med Surg (Lond) 2022; 82:104699. [PMID: 36268330 PMCID: PMC9577665 DOI: 10.1016/j.amsu.2022.104699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance Latent autoimmune diabetes of adulthood is an autoimmune disease sharing similarities of type 1 and type 2 diabetics. It is also known as type 1.5 diabetes in adults. It occurs mostly at the age of 30–35 years. It is usually associated with other autoimmune diseases and patients usually have normal BMI. Patients are positive for glutamic acid dehydrogenase and islets cell autoantibodies with onset in adulthood. Case We present a case of a 42 year old female from the capital city of Nepal who presented with chief complaints of excessive thirst and increased frequency of micturition. . She also reported feeling hungry most of the time. She added having symptoms of dry mouth, fatigue and occasional dizziness. Clinical findings and investigations Fasting and post prandial blood glucose, Hba1c, blood pH and bicarbonate, Islet cell antibodies, Glutamic Acid Decarboxylase (GAD) and urine ketones were sent for diagnosis. Intervention and outcome The patient was started on basal bolus glargine, 14 units and rapid acting insulin, lispro 6unit each with breakfast, lunch, and dinner. Beside insulin, the patient was started on statin (10mg, rosuvastatin) and aspirin (75mg, PO). In subsequent follow-up, her HbA1c level dropped in a few months. Conclusion There are no studies found in LADA in Nepal. Our case report tends to highlight the importance of clinical recognition of LADA and raise awareness and importance of diagnostic methods to differentiate between Type 1, Type 2 DM and LADA. LADA is under diagnosed in many countries including Nepal. LADA is an autoimmune disease sharing a wide range of similarities of type 1 and type 2 diabetes. Patients are positive for glutamic acid dehydrogenase and islets cell autoantibodies with onset in adulthood. LADA patients required insulin therapy earlier as compared to that of Type 2 diabetes patients.
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Affiliation(s)
| | | | | | - Arjun Kandel
- Department of Medicine, Flatland Vascular Associates, Brooklyn New York, USA
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Abstract
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.
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12
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Xenou M, Zoupas I, Lygnos D, Fousteris E. Diabetic ketoacidosis as first presentation of latent autoimmune diabetes in adults in a patient with hashitoxicosis as first presentation of Hashimoto's thyroiditis: a case report. J Med Case Rep 2022; 16:297. [PMID: 35918735 PMCID: PMC9347147 DOI: 10.1186/s13256-022-03523-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/10/2022] [Indexed: 11/28/2022] Open
Abstract
Background Latent autoimmune diabetes in adults is an infrequent form of autoimmune diabetes mellitus, while Hashimoto’s thyroiditis, the most common thyroid disease in adults, rarely manifests as thyrotoxicosis. The concurrent initial presentation of these two autoimmune disorders is extremely rare. Case presentation A 29-year-old male of Albanian descent presented after being hospitalized owing to diabetic ketoacidosis. The diagnosis of type 1 diabetes mellitus was placed, and intensified insulin therapy was initiated. Medical history was not of significance except a 5 kg weight loss within 2 months. The patient presented with recurrent episodes of hypoglycemia, and the doses of preprandial and basal insulin were reduced. The differential diagnosis included type 1 diabetes mellitus “honeymoon” period or another type of diabetes mellitus. His serological tests only revealed positive autoantibodies against glutamic acid decarboxylase 65 and C-peptide. The diagnosis leaned toward latent autoimmune diabetes in adults, and the therapeutic approach involved cessation of preprandial insulin therapy, regulation, and subsequent discontinuation of basal insulin and introduction of metformin. Two years later, basal insulin was reintroduced along with a glucagon-like peptide-receptor agonist and metformin. Further physical examination during the initial visit disclosed upper limb tremor, lid lag, excessive sweating, increased sensitivity to heat, and tachycardia. Laboratory tests were indicative of hashitoxicosis (suppressed level of thyroid-stimulating hormone, high levels of total and free thyroid hormones, positive anti-thyroglobulin and anti-thyroid peroxidase, and negative anti-thyroid-stimulating hormone receptor). Thyroid-stimulating hormone level was spontaneously restored, but an increase was observed during follow-up. Levothyroxine was administrated for 2 years until the patient had normal thyroid function. Conclusions The prevalence of thyroid autoantibodies in patients with latent autoimmune diabetes in adults ranges from 20% to 30%. This correlation can be attributed to genetic involvement as well as disorders of immune tolerance to autoantigens. Hence, this report gives prominence to the holistic approach and consideration of comorbidities in patients with diabetes mellitus.
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Affiliation(s)
- Maria Xenou
- Mediterranean Diabetes and Obesity Clinics (MEDOC), Athens, Santorini, Greece.,Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Zoupas
- Mediterranean Diabetes and Obesity Clinics (MEDOC), Athens, Santorini, Greece. .,Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Dimitrios Lygnos
- Mediterranean Diabetes and Obesity Clinics (MEDOC), Athens, Santorini, Greece
| | - Evangelos Fousteris
- Mediterranean Diabetes and Obesity Clinics (MEDOC), Athens, Santorini, Greece
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Manisha AM, Shangali AR, Mfinanga SG, Mbugi EV. Prevalence and factors associated with latent autoimmune diabetes in adults (LADA): a cross-sectional study. BMC Endocr Disord 2022; 22:175. [PMID: 35804315 PMCID: PMC9270809 DOI: 10.1186/s12902-022-01089-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Latent Autoimmune Diabetes in Adults (LADA) is a slowly progressive Type 1 diabetes subgroup with onset during middle age. Studies report that about 10% of adults initially diagnosed with clinical Type 2 diabetes (T2D) have LADA. Inappropriate diagnosis and mismanagement of the LADA can increase the risk of diabetic complications, which affect the quality of life and is the cause of increased mortality. In low-income countries setting, data regarding the magnitude of LADA is limited. We carried out this study to estimate the burden of misdiagnosed LADA among T2D patients in selected health facilities in Dar es Salaam and to bring awareness to the use of Glutamic Acid Decarboxylase (GAD) autoantibody in screening for LADA. METHODOLOGY We enrolled 186 phenotypically T2D patients in this cross-sectional study, through a standardized data collection tool we obtained participants' demographic and clinical information. For testing GAD levels, we used a double-antibody Enzyme-Linked Immunosorbent Assay (ELISA). The Fisher's Exact and student t-tests were used to test the significance of the statistical associations of the glycaemic control and diabetes complications between T2D and LADA. RESULTS Out of 186 patients, 156 gave conclusive GAD Ab ELISA reading with LADA accounting for 5.1% (95% CI: 2.5 - 10.0). The mean age of subjects was 54.3 years (Range: 33-85 years). The parameters such as mean age, family history of diabetes mellitus status, Fasting Blood Glucose, clinical characteristics, and complications did not show significant statistical differences between patients with LADA and Type 2 diabetes. However, all LADA- Human Immunodeficiency Virus (HIV) comorbid patients had retinopathy, which was statistically insignificant in 20 (87%) T2D-HIV comorbid patients (p = 0.669). Neither neuropathy, nephropathy, nor Diabetic Mellitus (D.M.) foot syndrome was observed among LADA-HIV comorbid patients. Nevertheless, 22 (95.7%), 3 (13%), and 2 (8.7%) of T2D-HIV comorbidity had neuropathy, nephropathy, or D.M. foot syndrome, respectively. CONCLUSIONS The study established a LADA prevalence of 5.1% among T2D patients and has shown the role of GAD autoantibody in the screening for LADA. The study calls for a well- designed larger longitudinal study to generate strong evidence on the association of risk factors and complications associated with the LADA. This will develop robust evidence on the association of risk factors and complications associated with the LADA and T2D.
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Affiliation(s)
- Anselmo M. Manisha
- Department Biochemistry, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
- Department of Biochemistry and Physiology, Mwanza University, P.O. Box 1719, Mwanza, Tanzania
| | - Aminiel R. Shangali
- Department of Biochemistry and Physiology, Mwanza University, P.O. Box 1719, Mwanza, Tanzania
- Department of Parasitology, Microbiology and Immunology, Mwanza University, P.O. Box 1719, Mwanza, Tanzania
| | - Sayoki G. Mfinanga
- National Institute for Medical Research, P.O. Box 3436, Dar es salaam, Tanzania
- Department of Epidemiology and Statistics, School of Public Health, Muhimbili University of Health, and Allied Science, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Erasto V. Mbugi
- Department Biochemistry, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
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Oyibo SO. Partial Remission of Diabetes in a Young Adult While Testing Positive for Several Islet Cell Autoantibodies: A Case Report, Literature Review, and Patient Perspective. Cureus 2022; 14:e25746. [PMID: 35702638 PMCID: PMC9177224 DOI: 10.7759/cureus.25746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 12/02/2022] Open
Abstract
Type 1 diabetes is a chronic disease characterized by abnormal metabolism and hyperglycemia due to insulin deficiency. There is a rapid decline in insulin production due to autoimmune destruction of the pancreatic beta cells. Partial remission (honeymoon phase) of type 1 diabetes is common in children and young adults with newly diagnosed type 1 diabetes. There is temporary restoration of beta cell function such that little or no exogenous insulin is required. Stopping insulin therapy soon after an emergency admission requiring intravenous insulin and subsequent subcutaneous insulin therapy can be frightening for both patient and healthcare provider. Affected patients require education and support during this period. This report describes a case of a 28-year-old man who presented to the emergency department with features of type 1 diabetes and diabetic ketoacidosis. He was treated with intravenous fluids and intravenous insulin and discharged on a subcutaneous insulin regimen. Despite testing positive for several types of islet cell autoantibodies, the patient was able to stop insulin therapy within three months of diagnosis. The patient maintained a self-initiated low-carbohydrate diet, regular weight-reducing exercise, and normal glucose levels without the need for insulin therapy. The honeymoon phase of type 1 diabetes, latent autoimmune diabetes, and ketosis-prone type 2 diabetes are discussed as important differential diagnoses.
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Affiliation(s)
- Samson O Oyibo
- Diabetes and Endocrinology, Peterborough City Hospital, Peterborough, GBR
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15
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Ng YS, Lim AZ, Panagiotou G, Turnbull DM, Walker M. Endocrine Manifestations and New Developments in Mitochondrial Disease. Endocr Rev 2022; 43:583-609. [PMID: 35552684 PMCID: PMC9113134 DOI: 10.1210/endrev/bnab036] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Indexed: 11/19/2022]
Abstract
Mitochondrial diseases are a group of common inherited diseases causing disruption of oxidative phosphorylation. Some patients with mitochondrial disease have endocrine manifestations, with diabetes mellitus being predominant but also include hypogonadism, hypoadrenalism, and hypoparathyroidism. There have been major developments in mitochondrial disease over the past decade that have major implications for all patients. The collection of large cohorts of patients has better defined the phenotype of mitochondrial diseases and the majority of patients with endocrine abnormalities have involvement of several other systems. This means that patients with mitochondrial disease and endocrine manifestations need specialist follow-up because some of the other manifestations, such as stroke-like episodes and cardiomyopathy, are potentially life threatening. Also, the development and follow-up of large cohorts of patients means that there are clinical guidelines for the management of patients with mitochondrial disease. There is also considerable research activity to identify novel therapies for the treatment of mitochondrial disease. The revolution in genetics, with the introduction of next-generation sequencing, has made genetic testing more available and establishing a precise genetic diagnosis is important because it will affect the risk for involvement for different organ systems. Establishing a genetic diagnosis is also crucial because important reproductive options have been developed that will prevent the transmission of mitochondrial disease because of mitochondrial DNA variants to the next generation.
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Affiliation(s)
- Yi Shiau Ng
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Albert Zishen Lim
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Grigorios Panagiotou
- Department of Diabetes and Endocrinology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Doug M Turnbull
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mark Walker
- Department of Diabetes and Endocrinology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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16
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Class I MHC Polymorphisms Associated with Type 2 Diabetes in the Mexican Population. Genes (Basel) 2022; 13:genes13050772. [PMID: 35627158 PMCID: PMC9140925 DOI: 10.3390/genes13050772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/16/2022] [Accepted: 04/23/2022] [Indexed: 01/27/2023] Open
Abstract
Type 2 diabetes (T2D) has been linked to the expression of Human Leukocyte Antigens, principally to the Major Histocompatibility Complex Class II, with only scarce reports of Major Histocompatibility Complex Class I in specific populations. The objective of the present work was to explore the presence of polymorphisms in the MHC Class I related to T2D in the Mexican population using the Genome-Wide Association Studies Slim Initiative in Genomic Medicine of the Americas (GWAS SIGMA) database. This database contains information on 3848 Mexican individuals with T2D and 4366 control individuals from the same population without a clinical or hereditary history of the disease. The searching criteria considered a p-value of <0.005 and an odds ratio (OR) of >1.0. Ten novel, statistically significant nucleotide variants were identified: four polymorphisms associated with HLA-A (A*03:01:01:01) and six with HLA-C (C*01:02:01:01). These alleles have a high prevalence in Latin American populations and could potentially be associated with autoimmunity mechanisms related to the development of T2D complications.
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Lin T, Cai Y, Tang L, Lian Y, Liu M, Liu C. Efficacy and safety of sitagliptin and insulin for latent autoimmune diabetes in adults: a systematic review and meta-analysis. J Diabetes Investig 2022; 13:1506-1519. [PMID: 35445591 PMCID: PMC9434588 DOI: 10.1111/jdi.13814] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/20/2022] [Accepted: 04/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The optimal therapy for latent autoimmune diabetes in adults (LADA) remains undefined. Increasing evidence have shown that sitagliptin and insulin treatment can benefit patients with LADA, the efficacy still lacks systematic evaluation. METHODS We retrieved the literature in PubMed, Cochrane Library, Embase, Web of Science, and CNKI from inception to August 2021. Randomized controlled trials (RCTs) comparing the effects of sitagliptin plus insulin with insulin alone in LADA patients were identified. The outcome measures included parameters of glycemic control, β cell function, body mass index, and adverse events. The Review Manager 5.2 and Stata 14.0 were utilized for data analysis. RESULTS Eight RCTs involving 295 participants were identified. Sitagliptin and insulin treatment lowered hemoglobin A1c (HbA1c, WMD = -0.36, 95% CI: -0.61 to -0.10; I2 = 91.6%), increased fasting C-peptide (FCP, WMD = 0.08, 95% CI: -0.02 to 0.17; I2 = 88.8%), and had fewer adverse events compared with insulin alone. The inter-study heterogeneity, potential publication bias and other factors may interpret asymmetrical presentation of funnel plots. There was no significant association between sitagliptin plus insulin treatment and levels of HbA1c or FCP, regardless of the duration of intervention and sample size. CONCLUSIONS Sitagliptin combined with insulin can achieve better glycemic control and improve islet β cell function with lower incidence of hypoglycaemia compared with insulin alone, which provides an effective and tolerated therapeutic regimen for LADA patients. However, further well-designed and rigorous RCTs are required to validate this benefit due to the limited methodology quality of included trials.
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Affiliation(s)
- Tong Lin
- The First School of Clinical Medical Sciences, Guangzhou University of Chinese, Medicine, Guangzhou, 510405, China
| | - Yinhe Cai
- The First School of Clinical Medical Sciences, Guangzhou University of Chinese, Medicine, Guangzhou, 510405, China
| | - Liting Tang
- Department of Endocrinology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Youwei Lian
- The First School of Clinical Medical Sciences, Guangzhou University of Chinese, Medicine, Guangzhou, 510405, China
| | - Min Liu
- Department of Endocrinology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Chaonan Liu
- Department of Endocrinology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
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18
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Costa JR, Mestre A, Miranda MS, Ferreira FH, Abuowda Y. A Case of Late Diagnosis of Latent Autoimmune Diabetes in Adults. Cureus 2022; 14:e21826. [PMID: 35282513 PMCID: PMC8904035 DOI: 10.7759/cureus.21826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/05/2022] Open
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Zhang JX, Berry J, Kim NM, Gray JJ, Fotheringham S, Sauerwein TJ. Two Fifth-Generation Fighter Pilots Discovered with Latent Autoimmune Diabetes. Aerosp Med Hum Perform 2022; 93:106-110. [PMID: 35105428 DOI: 10.3357/amhp.5901.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Fighter pilots undergo extensive medical screening but may still miss rare diseases like latent autoimmune diabetes in adults (LADA). LADA patients have circulating autoantibodies directed against pancreatic beta cell antigens and present with frank diabetes late in life which may elude conventional military flight screening.CASE REPORT: Two fifth-generation fighter pilots, a 38-yr-old man (patient 1) and a 27-yr-old man (patient 2), with no significant past medical histories developed symptoms of fatigue, weight loss, episodic polyuria, and arthralgia. Patient 1's symptoms were initially thought to have been caused by COVID-19, but he subsequently tested negative for viral infection. Lab work instead showed elevated TSH, HgbA1C 11.4%, positive GAD-65, anti-TPO, and anti-islet cell antibodies. Patient 2 developed symptoms following a military deployment and a 72-h diarrheal illness. Due to flight status, patient 2 did not seek expert medical attention for several months, but lab work found HgbA1C of 10.4%, positive GAD-66, and ZnT8 antibodies. Both patients were started on insulin therapy. Patient 1 was also started on levothyroxine for hypothyroidism and retired from flying duties. Patient 2 eventually transitioned to metformin without insulin and returned to flying duties with an aeromedical waiver.DISCUSSION: Our patients maintained peak physical fitness throughout their selection and aviation careers, which likely delayed their clinical presentation. Current USAF flight rules prohibit insulin use with flying fighter aircraft. Early antibody screening during pilot selection may be a cost-effective means of diagnosis as traditional screening techniques are unlikely to detect LADA.Zhang JX, Berry J, Kim NM, Gray JJ, Fotheringham S, Sauerwein TJ. Two fifth-generation fighter pilots discovered with latent autoimmune diabetes. Aerosp Med Hum Perform. 2022; 93(2):106-110.
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20
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Hu J, Zhang R, Zou H, Xie L, Zhou Z, Xiao Y. Latent Autoimmune Diabetes in Adults (LADA): From Immunopathogenesis to Immunotherapy. Front Endocrinol (Lausanne) 2022; 13:917169. [PMID: 35937817 PMCID: PMC9350734 DOI: 10.3389/fendo.2022.917169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/26/2022] [Indexed: 11/26/2022] Open
Abstract
Latent autoimmune diabetes in adults (LADA) is a type of diabetes characterized by slow autoimmune damage of pancreatic β cells without insulin treatment in the early clinical stage. There are differences between LADA and classical type 1 diabetes (T1D) and type 2 diabetes (T2D) in genetic background, autoimmune response, rate of islet function decline, clinical metabolic characteristics, and so on. The disease progression and drug response of patients with LADA are closely related to the level of islet autoimmunity, thus exploring the pathogenesis of LADA is of great significance for its prevention and treatment. Previous studies reported that adaptive immunity and innate immunity play a critical role in the etiology of LADA. Recent studies have shown that the intestinal microbiota which impacts host immunity hugely, participates in the pathogenesis of LADA. In addition, the progression of autoimmune pancreatic β cell destruction in LADA is slower than in classical T1D, providing a wider window of opportunities for intervention. Therefore, therapies including antidiabetic drugs with immune-regulation effects and immunomodulators could contribute to promising interventions for LADA. We also shed light on potential interventions targeting the gut microbiota and gut-associated immunity, which may be envisaged to halt or delay the process of autoimmunity in LADA.
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21
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Huang J, Pearson JA, Wong FS, Wen L, Zhou Z. Innate immunity in latent autoimmune diabetes in adults. Diabetes Metab Res Rev 2022; 38:e3480. [PMID: 34156143 PMCID: PMC8813511 DOI: 10.1002/dmrr.3480] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 11/06/2022]
Abstract
Latent autoimmune diabetes in adults (LADA) is an autoimmune disease that shares some genetic, immunological and clinical features with both type 1 diabetes and type 2 diabetes. Immune cells including CD4+ T cells, CD8+ T cells, B cells, macrophages and dendritic cells (DCs) have been detected in the pancreas of patients with LADA and a rat model of LADA. Therefore, similar to type 1 diabetes, the pathogenesis of LADA may be caused by interactions between islet β-cells and innate and adaptive immune cells. However, the role of the immunity in the initiation and progression of LADA remains largely unknown. In this review, we have summarized the potential roles of innate immunity and immune-modulators in LADA development. Furthermore, we have examined the evidence and discussed potential innate immunological reasons for the slower development of LADA compared with type 1 diabetes. More in-depth mechanistic studies are needed to fully elucidate the roles of innate immune-associated genes, molecules and cells in their contributions to LADA pathogenesis. Undertaking these studies will greatly enhance the development of new strategies and optimization of current strategies for the diagnosis and treatment of the disease.
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Affiliation(s)
- Juan Huang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Internal Medicine, Section of Endocrinology, School of Medicine, Yale University, New Haven, Connecticut, USA
| | | | - F. Susan Wong
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Li Wen
- Department of Internal Medicine, Section of Endocrinology, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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22
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Pan N, Yang S, Niu X. Latent Autoimmune Diabetes in Adults and Metabolic Syndrome-A Mini Review. Front Endocrinol (Lausanne) 2022; 13:913373. [PMID: 35837301 PMCID: PMC9273866 DOI: 10.3389/fendo.2022.913373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Latent autoimmune diabetes in adults (LADA) is a heterogeneous subtype of diabetes characterized by islet cell destruction mediated by islet autoimmunity and insulin resistance. Metabolic syndrome (MetS) is a state in which many risk factors for metabolic and cardiovascular diseases accumulate in an individual. Based on clinical data, this review covers the prevalence of MetS in LADA, focusing on the risk associated with and the role of insulin resistance in the development of LADA from the perspective of inflammatory factors, environmental factors, and the gut microbiota, aiming to improve our understanding of this condition.
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Affiliation(s)
- Niansi Pan
- Department of Endocrinology, Changzhi Medical College, Changzhi, China
| | - Shimei Yang
- Department of Endocrinology, Changzhi Medical College, Changzhi, China
| | - Xiaohong Niu
- Department of Endocrinology, Changzhi Medical College Affiliated Heji Hospital, Changzhi, China
- *Correspondence: Xiaohong Niu,
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23
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Shpilsky GF, Takahashi H, Aristarkhova A, Weil M, Ng N, Nelson KJ, Lee A, Zheng H, Kühtreiber WM, Faustman DL. Bacillus Calmette-Guerin 's beneficial impact on glucose metabolism: evidence for broad based applications. iScience 2021; 24:103150. [PMID: 34646988 PMCID: PMC8501688 DOI: 10.1016/j.isci.2021.103150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/03/2021] [Accepted: 09/16/2021] [Indexed: 11/25/2022] Open
Abstract
Bacillus Calmette-Guerin (BCG) vaccinations improve glycemic control in juvenile-onset Type I diabetes (T1D), an effect driven by restored sugar transport through aerobic glycolysis. In a pilot clinical trial, T1D, but not latent autoimmune diabetes of adults (LADA), exhibited lower blood sugars after multidose BCG. Using a glucose transport assay, monocytes from T1D subjects showed a large stimulation index with BCG exposures; LADA subjects showed minimal BCG-induced sugar responsiveness. Monocytes from T1D, type 2 diabetes (T2D), and non-diabetic controls (NDC) were all responsive in vitro to BCG by augmented sugar utilization. Adults with prior neonatal BCG vaccination show accelerated glucose transport decades later. Finally, in vivo experiments with the NOD mouse (a T1D model) and obese db/db mice (a T2D model) confirm BCG's blood-sugar-lowering and accelerated glucose metabolism with sufficient dosing. Our results suggest that BCG's benefits for glucose metabolism may be broadly applicable to T1D and T2D, but less to LADA. A pilot trial of BCG vaccinations to T1D showed reduced blood sugars but not in LADA Monocytes from T1D and to some degree T2D display stimulated glucose transport BCG vaccinations at birth show accelerated glucose transport decades later In vivo mouse models of both T1D and T2D demonstrate BCG-induced blood sugar lowering
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Affiliation(s)
- Gabriella F Shpilsky
- Massachusetts General Hospital, Immunobiology Laboratories, Boston, MA 02129, USA
| | - Hiroyuki Takahashi
- Massachusetts General Hospital, Immunobiology Laboratories, Boston, MA 02129, USA
| | - Anna Aristarkhova
- Massachusetts General Hospital, Immunobiology Laboratories, Boston, MA 02129, USA
| | - Michele Weil
- Massachusetts General Hospital, Diabetes Unit, Boston, MA 02129, USA
| | - Nathan Ng
- Massachusetts General Hospital, Immunobiology Laboratories, Boston, MA 02129, USA
| | - Kacie J Nelson
- Massachusetts General Hospital, Immunobiology Laboratories, Boston, MA 02129, USA
| | - Amanda Lee
- Massachusetts General Hospital, Immunobiology Laboratories, Boston, MA 02129, USA
| | - Hui Zheng
- Massachusetts General Hospital and Harvard Medical School, Statistics Department, Boston, MA 02129, USA
| | - Willem M Kühtreiber
- Massachusetts General Hospital, Immunobiology Laboratories, Boston, MA 02129, USA.,Massachusetts General Hospital and Harvard Medical School, Immunobiology Laboratories, Boston, MA 02129, USA
| | - Denise L Faustman
- Massachusetts General Hospital, Immunobiology Laboratories, Boston, MA 02129, USA.,Massachusetts General Hospital and Harvard Medical School, Immunobiology Laboratories, Boston, MA 02129, USA
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Forst T, Choudhary P, Schneider D, Linetzky B, Pozzilli P. A practical approach to the clinical challenges in initiation of basal insulin therapy in people with type 2 diabetes. Diabetes Metab Res Rev 2021; 37:e3418. [PMID: 33098260 PMCID: PMC8519070 DOI: 10.1002/dmrr.3418] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/17/2020] [Accepted: 08/09/2020] [Indexed: 12/18/2022]
Abstract
Initiating insulin therapy with a basal insulin analogue has become a standard of care in the treatment of type 2 diabetes mellitus (T2DM). Despite increasing choices in pharmacological approaches, intensified glucose monitoring and improvements in quality of care, many patients do not achieve the desired level of glycaemic control. Although insulin therapy, when optimized, can help patients reach their glycaemic goals, there are barriers to treatment initiation on both the side of the patient and provider. Providers experience barriers based on their perceptions of patients' capabilities and concerns. They may lack the confidence to solve the practical problems of insulin therapy and avoid decisions they perceive as risky for their patients. In this study, we review recommendations for basal insulin initiation, focussing on glycaemic targets, titration, monitoring, and combination therapy with non-insulin anti-hyperglycaemic medications. We provide practical advice on how to address some of the key problems encountered in everyday clinical practice and give recommendations where there are gaps in knowledge or guidelines. We also discuss common challenges faced by people with T2DM, such as weight gain and hypoglycaemia, and how providers can address and overcome them.
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Affiliation(s)
- Thomas Forst
- Department of Endocrinology and Metabolic DiseasesUniversitatsmedizin der Johannes GutenbergMainzGermany
- Clinical Research ServicesManhheimGermany
| | - Pratik Choudhary
- Department of Diabetes and Nutritional SciencesKing's CollegeLondonUK
| | | | | | - Paolo Pozzilli
- Department of Endocrinology and Metabolic DiseasesUniversità Campus Bio‐MedicoRomeItaly
- Centre of ImmunobiologyBarts and the London School of MedicineQueen Mary University of LondonUK
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25
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Kaur N, Kumar V, Nayak SK, Wadhwa P, Kaur P, Sahu SK. Alpha-amylase as molecular target for treatment of diabetes mellitus: A comprehensive review. Chem Biol Drug Des 2021; 98:539-560. [PMID: 34173346 DOI: 10.1111/cbdd.13909] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 01/13/2023]
Abstract
The alpha (α)-amylase is a calcium metalloenzyme that aids digestion by breaking down polysaccharide molecules into smaller ones such as glucose and maltose. In addition, the enzyme causes postprandial hyperglycaemia and blood glucose levels to rise. α-Amylase is a well-known therapeutic target for the treatment and maintenance of postprandial blood glucose elevations. Various enzymatic inhibitors, such as acarbose, miglitol and voglibose, have been found to be effective in targeting this enzyme, prompting researchers to express an interest in developing potent alpha-amylase inhibitor molecules. The review mainly focused on designing different derivatives of drug molecules such as benzofuran hydrazone, indole hydrazone, spiroindolone, benzotriazoles, 1,3-diaryl-3-(arylamino) propan-1-one, oxadiazole and flavonoids along with their target-receptor interactions, IC50 values and other biological activities.
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Affiliation(s)
- Navjot Kaur
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Vanktesh Kumar
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Surendra Kumar Nayak
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Pankaj Wadhwa
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Paranjit Kaur
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Sanjeev Kumar Sahu
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
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Tam AA, Ozdemir D, Bestepe N, Dellal FD, Bilginer MC, Faki S, Bicer C, Ersoy R, Cakir B. Low rate of latent autoimmune diabetes in adults (LADA) in patients followed for type 2 diabetes: A single center's experience in Turkey. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 64:584-590. [PMID: 34033299 PMCID: PMC10118961 DOI: 10.20945/2359-3997000000268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective In this study, we aimed to determine the frequency of and the clinical and metabolic features of patients with latent autoimmune diabetes in adults (LADA) at a single center in Turkey. Methods Patients over 30 years of age diagnosed with type 2 diabetes who did not require insulin for a minimum of 6 months following diagnosis were included. Data from 324 patients (163 women; 161 men), with a mean age of 54.97 ± 7.53 years, were analyzed in the study. Levels of antibodies to glutamate decarboxylase (anti-GAD) were measured in all patients, and LADA was diagnosed in patients testing positive for anti-GAD antibodies. Results Anti-GAD positivity was identified in 5 patients (1.5%). Family history of diabetes, body mass index (BMI), age, sex distribution, insulin resistance, serum triglycerides, high-density lipoprotein, and low-density lipoprotein were similar in the LADA and type 2 diabetes patients. Median HbA1c was significantly higher (10.8% vs. 7.38%, p = 0.002) and fasting C-peptide was lower (0.75 ng/mL vs. 2.82 ng/mL, p = 0.009) in patients with LADA compared to in those with type 2 diabetes. Among the 5 patients with LADA, 4 were positive for antithyroid peroxidase antibodies. The median disease duration was relatively shorter among patients with LADA (4 years vs. 7 years, p = 0.105). Conclusion We observed a LADA frequency of 1.5% among Turkish patients followed for type 2 diabetes. The presence of obesity and metabolic syndrome did not exclude LADA, and patients with LADA had worse glycemic control than patients with type 2 diabetes did.
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Affiliation(s)
- Abbas Ali Tam
- Department of Endocrinology and Metabolism, Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey,
| | - Didem Ozdemir
- Department of Endocrinology and Metabolism, Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Nagihan Bestepe
- Department of Endocrinology and Metabolism, Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Fatma Dilek Dellal
- Department of Endocrinology and Metabolism, Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Muhammet Cuneyt Bilginer
- Department of Endocrinology and Metabolism, Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Sevgul Faki
- Department of Endocrinology and Metabolism, Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Cemile Bicer
- Department of Biochemistry, Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism, Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
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Pinheiro MM, Pinheiro FMM, Diniz SN, Fabbri A, Infante M. Combination of vitamin D and dipeptidyl peptidase-4 inhibitors (VIDPP-4i) as an immunomodulation therapy for autoimmune diabetes. Int Immunopharmacol 2021; 95:107518. [PMID: 33756226 DOI: 10.1016/j.intimp.2021.107518] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/18/2022]
Abstract
Type 1 diabetes (T1D) and latent autoimmune diabetes in adults (LADA) represent the most common types of autoimmune diabetes and are characterized by different age of onset, degrees of immune-mediated destruction of pancreatic beta cells and rates of disease progression towards insulin dependence. Several immunotherapies aimed to counteract autoimmune responses against beta cells and preserve beta-cell function are currently being investigated, particularly in T1D. Preliminary findings suggest a potential role of combination therapy with vitamin D and dipeptidyl peptidase-4 (DPP-4) inhibitors (VIDPP-4i) in preserving beta-cell function in autoimmune diabetes. This manuscript aims to provide a comprehensive overview of the immunomodulatory properties of vitamin D and DPP-4 inhibitors, as well as the rationale for investigation of their combined use as an immunomodulation therapy for autoimmune diabetes.
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Affiliation(s)
- Marcelo Maia Pinheiro
- UNIVAG, University Center, Dom Orlando Chaves Ave, 2655 - Cristo Rei, Várzea Grande, 78118-000 Mato Grosso, Brazil; Universidade Anhanguera de São Paulo - SP, 3305, Raimundo Pereira de Magalhães Ave., Pirituba, São Paulo, 05145-200 São Paulo, Brazil.
| | - Felipe Moura Maia Pinheiro
- Hospital de Base, Faculdade de Medicina de São José do Rio Preto FAMERP - SP, 5546, Brigadeiro Faria Lima Ave, Vila São Pedro, São José do Rio Preto, 15015-500 São Paulo, Brazil
| | - Susana Nogueira Diniz
- Universidade Anhanguera de São Paulo - SP, 3305, Raimundo Pereira de Magalhães Ave., Pirituba, São Paulo, 05145-200 São Paulo, Brazil
| | - Andrea Fabbri
- Diabetes Research Institute Federation (DRIF), Division of Endocrinology and Diabetes, CTO Andrea Alesini Hospital, ASL Roma 2, Department of Systems Medicine, University of Rome Tor Vergata, Via San Nemesio 21, 00145 Rome, Italy
| | - Marco Infante
- Diabetes Research Institute Federation (DRIF), Division of Endocrinology and Diabetes, CTO Andrea Alesini Hospital, ASL Roma 2, Department of Systems Medicine, University of Rome Tor Vergata, Via San Nemesio 21, 00145 Rome, Italy; UniCamillus, Saint Camillus International University of Health Sciences, Via di Sant'Alessandro, 8, 00131 Rome, Italy; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Via San Nemesio 21, 00145 Rome, Italy.
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Moosaie F, Meftah N, Deravi N, Abouhamzeh K, Firouzabadi FD, Khaloo P, Mansournia MA, Fatemi Abhari SM, Nakhjavani M, Esteghamati A. Prevalence of diabetes-associated autoantibodies among patients presenting with type 2 diabetes and related metabolic differences. Prim Care Diabetes 2021; 15:169-174. [PMID: 32798203 DOI: 10.1016/j.pcd.2020.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/03/2020] [Accepted: 07/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND To explores the prevalence of autoantibodies (zinc transporter 8 autoantibodies (ZnT8A), antibodies to insulin (IAAs), glutamic acid decarboxylase autoantibody (GAD65)), the relation of the type of positive autoantibody and the number of positive autoantibodies with the glycemic and lipid profile of the patients with LADA (Latent Autoimmune Diabetes in Adults) and compares it to the metabolic profile of patients presenting with type 2 diabetes (T2DM). METHODS 263 patients with T2DM were recruited for this cross-sectional study in Tehran, Iran. Data from patients included complete medical history, GAD65, ZnT8A, IAA and routine metabolic laboratory workup. Assay for autoantibodies were conducted using ELISA kits. The association between autoantibodies and glycemic and lipid profile of patients with diabetes was assessed using univariate and multivariate regression analysis. RESULTS Our study revealed that among 263 patients with T2DM, 29 (11%) cases were positive for IAAs, 9 (3.4%) for ZnT8A, and 12 (4.6%) for GAD65. Six (2.3%) of the patients had triple positive antibodies. Patients with positive results were younger, had lower body mass index (BMI), c-peptide, triglyceride, low-density lipoprotein (LDL), and higher high-density lipoprotein (HDL), HbA1c and fasting blood glucose (FBG) levels. Triple antibody positivity was significantly associated with lower levels of C-Peptide, Triglycerides, FBG, and HbA1c compared to triple negative antibodies. CONCLUSION Patients with LADA positive for either of the autoantibodies (GAD65, ZnT8 and IAA) presented with worse glycemic control. Measurement of these autoantibodies can assist in discrimination of these patients and help with earlier control of glycemic profile.
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Affiliation(s)
- Fatemeh Moosaie
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Meftah
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloofar Deravi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Student's Research committee, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kosar Abouhamzeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Dehghani Firouzabadi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Khaloo
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Kaur R, Kim D, Cutfield R, Booth M, Plank L, Murphy R. Good Glycemic Outcomes Following Bariatric Surgery Among Patients With Type 2 Diabetes, Obesity, and Low-Titer GAD Antibodies. Diabetes Care 2021; 44:607-609. [PMID: 33310883 DOI: 10.2337/dc20-0804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 11/13/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate diabetes remission after bariatric surgery by presence of GAD antibody among those with obesity and type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Screening GAD was performed in 221 patients with T2D and obesity referred for bariatric surgery. Nine of 16 patients with GAD and 112 of 205 without GAD proceeded with surgery. Diabetes remission and weight loss were compared by GAD presence. RESULTS The group with GAD had levels 16-91 IU/mL. Those with and without GAD were similar with regard to age, BMI, diabetes duration, proportion treated with insulin, HbA1c, and C-peptide (1,354 ± 548 vs. 1,358 ± 487 pmol/L). At 1 and 5 years postoperatively, the two groups achieved similar BMI reduction and diabetes remission (67% vs. 73%, P = 0.71, and 56% vs. 57%, P = 1.0). CONCLUSIONS Low-titer GAD in patients with T2D and retained C-peptide should not be a deterrent for bariatric surgery when the principal aim is diabetes remission.
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Affiliation(s)
- Ruveena Kaur
- Diabetes Centre, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - David Kim
- Diabetes Centre, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Richard Cutfield
- Diabetes Centre, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Michael Booth
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Lindsay Plank
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- Diabetes Centre, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand .,Department of Medicine, University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand
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Großmann S, Hoffmann U, Girlich C. [Confusion, tachypnea, and tachycardia in a 71-year-old man with type 2 diabetes mellitus]. Internist (Berl) 2021; 62:672-678. [PMID: 33411015 PMCID: PMC7788531 DOI: 10.1007/s00108-020-00930-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 11/14/2022]
Abstract
Bei Patienten mit Diabetes mellitus Typ 2 muss im Falle einer unklaren Bewusstseinsstörung und/oder Bauchschmerzen eine Natrium/Glukose-Kotransporter-2(SGLT-2)-Inhibitor-induzierte diabetische Ketoazidose in die Differenzialdiagnose einbezogen werden. Dabei können die Blutzuckerspiegel trotz ausgeprägter Azidose nur moderat erhöht sein. Bei Nachweis ist eine umgehende intensivmedizinische Therapie unerlässlich.
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Affiliation(s)
- S Großmann
- Klinik für Pneumologie und konservative Intensivmedizin, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Deutschland.
| | - U Hoffmann
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Deutschland
| | - C Girlich
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Deutschland
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Štambuk T, Gornik O. Protein Glycosylation in Diabetes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1325:285-305. [PMID: 34495541 DOI: 10.1007/978-3-030-70115-4_14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diabetes mellitus is a group of metabolic disorders characterized by the presence of hyperglycaemia. Due to its high prevalence and substantial heterogeneity, many studies have been investigating markers that could identify predisposition for the disease development, differentiate between the various subtypes, establish early diagnosis, predict complications or represent novel therapeutic targets. N-glycans, complex oligosaccharide molecules covalently linked to proteins, emerged as potential markers and functional effectors of various diabetes subtypes, appearing to have the capacity to meet these requirements. For instance, it has been shown that N-glycome changes in patients with type 2 diabetes and that N-glycans can even identify individuals with an increased risk for its development. Moreover, genome-wide association studies identified glycosyltransferase genes as candidate causal genes for both type 1 and type 2 diabetes. N-glycans have also been suggested to have a major role in preventing the impairment of glucose-stimulated insulin secretion by modulating cell surface expression of glucose transporters. In this chapter we aimed to describe four major diabetes subtypes: type 1, type 2, gestational and monogenic diabetes, giving an overview of suggested role for N-glycosylation in their development, diagnosis and management.
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Affiliation(s)
- Tamara Štambuk
- Genos, Glycoscience Research Laboratory, Zagreb, Croatia.
| | - Olga Gornik
- University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
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Tittel SR, Sondern KM, Weyer M, Poeplau T, Sauer BM, Schebek M, Ludwig KH, Hammer F, Fröhlich-Reiterer E, Holl RW. Multicentre analysis of hyperglycaemic hyperosmolar state and diabetic ketoacidosis in type 1 and type 2 diabetes. Acta Diabetol 2020; 57:1245-1253. [PMID: 32488499 PMCID: PMC7496062 DOI: 10.1007/s00592-020-01538-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/18/2020] [Indexed: 02/06/2023]
Abstract
AIMS To compare diabetes patients with hyperglycaemic hyperosmolar state (HHS), diabetic ketoacidosis (DKA), and patients without decompensation (ND). METHODS In total, 500,973 patients with type 1 or type 2 diabetes of all ages registered in the diabetes patient follow-up (DPV) were included. Analysis was stratified by age (≤ / > 20 years) and by manifestation/follow-up. Patients were categorized into three groups: HHS or DKA-during follow-up according to the most recent episode-or ND. RESULTS At onset of diabetes, HHS criteria were met by 345 (68.4% T1D) and DKA by 9824 (97.6% T1D) patients. DKA patients had a lower BMI(-SDS) in both diabetes types compared to ND. HbA1c was higher in HHS/DKA. During follow-up, HHS occurred in 1451 (42.2% T1D) and DKA in 8389 patients (76.7% T1D). In paediatric T1D, HHS/DKA was associated with younger age, depression, and dyslipidemia. Pump usage was less frequent in DKA patients. In adult T1D/T2D subjects, metabolic control was worse in patients with HHS/DKA. HHS and DKA were also associated with excessive alcohol intake, dementia, stroke, chronic kidney disease, and depression. CONCLUSIONS HHS/DKA occurred mostly in T1D and younger patients. However, both also occurred in T2D, which is of great importance in the treatment of diabetes. Better education programmes are necessary to prevent decompensation and comorbidities.
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Affiliation(s)
- S R Tittel
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology (ZIBMT), Ulm University, Albert-Einstein-Allee 41, 89081, Ulm, Germany.
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | | | - M Weyer
- Kamillus-Klinik Internal Medicine, Asbach, Germany
| | - T Poeplau
- Clemenshospital, Ludgerus-Kliniken GmbH, Münster, Germany
| | - B M Sauer
- Medical Clinic Internal Medicine, Spaichingen, Germany
| | | | - K-H Ludwig
- Paediatric Clinic of the Borromeans, Trier, Germany
| | - F Hammer
- Cnopf Children's Clinic, Nuremberg, Germany
| | | | - R W Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology (ZIBMT), Ulm University, Albert-Einstein-Allee 41, 89081, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
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Chen W, Chen X, Zhang M, Huang Z. The association of human leukocyte antigen class II (HLA II) haplotypes with the risk of Latent autoimmune diabetes of adults (LADA): Evidence based on available data. Gene 2020; 767:145177. [PMID: 32998048 DOI: 10.1016/j.gene.2020.145177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022]
Abstract
AIMS Latent autoimmune diabetes in adult (LADA), classified as between type 1 and type 2 diabetes mellitus, has received widespread attention. A number of studies have investigated the association between HLA DQA-DQB, DRB-DQB haplotypes and the onset of LADA. However, the conclusions remained inconsistent. Therefore, this study aims to clarify the impact of these HLA haplotypes on the pathogenesis of LADA. METHODS Systematic searches were carried out on the Medline, PubMed, Embase and Wan Fang respectively to investigate the association of LADA with HLA DQA-DQB, DRB-DQB up to June 05, 2020. We performed this retrospective research using meta-analysis. RESULTS The pooled results demonstrated that in Chinese, DQA1*05-DQB1*0201, DQA1*03-DQB1*0401, and DQA1*03-DQB1*0303 were statistically significantly associated with increasing the risk of LADA (P < 0.001), while DQA1*0102-DQB1*0602 was statistically significantly correlated with decreasing the susceptibility to the disease (P = 0.003). However, there was no obvious association found between DQA1*0201-DQB1*0201 (P = 0.984), DQA1*03-DQB1*0302 (P = 0.110), DQA1*0601-DQB1*0301 (P = 0.398) and LADA. In Japanese, DRB1*0802-DQB1*0302 (P = 0.003) and DRB1*0901-DQB1*0303 (P = 0.001), but not DRB1*0405-DQB1*0401 (P = 0.136), were found to be a risk factor for LADA. As for Caucasian, both DRB1*03-DQB1*0201 and DRB1*04-DQB1*0302 were predisposed to the development of LADA with a statistical significance (P < 0.001). CONCLUSION In all, HLA DQA-DQB, HLA DRB-DQB haplotypes might play a role in the risk of LADA, which could provide an improved understanding of LADA pathogenesis and the detection of susceptible HLA haplotypes in the diagnosis and therapy of this disease.
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Affiliation(s)
- Wenjun Chen
- Key Laboratory of Big Data Mining and Precision Drug Design of Guangdong Medical University, Key Laboratory for Research and Development of Natural Drugs of Guangdong Province, School of Pharmacy, Dongguan, Guangdong 523808, China; The Second School of Clinical Medicine, Guangdong Medical University, Dongguan, Guangdong 523808, China
| | - Xinlin Chen
- Key Laboratory of Big Data Mining and Precision Drug Design of Guangdong Medical University, Key Laboratory for Research and Development of Natural Drugs of Guangdong Province, School of Pharmacy, Dongguan, Guangdong 523808, China; The Second School of Clinical Medicine, Guangdong Medical University, Dongguan, Guangdong 523808, China
| | - Minting Zhang
- Key Laboratory of Big Data Mining and Precision Drug Design of Guangdong Medical University, Key Laboratory for Research and Development of Natural Drugs of Guangdong Province, School of Pharmacy, Dongguan, Guangdong 523808, China; The Second School of Clinical Medicine, Guangdong Medical University, Dongguan, Guangdong 523808, China
| | - Zunnan Huang
- Key Laboratory of Big Data Mining and Precision Drug Design of Guangdong Medical University, Key Laboratory for Research and Development of Natural Drugs of Guangdong Province, School of Pharmacy, Dongguan, Guangdong 523808, China; Marine Medical Research Institute of Guangdong Zhanjiang, Zhanjiang, Guangdong 524023, China.
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Affiliation(s)
- Alexandra E Butler
- Diabetes Research Center, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - David Misselbrook
- Department of Family Medicine, Royal College of Surgeons in Ireland - Bahrain, Adliya, Kingdom of Bahrain
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Maddaloni E, Moretti C, Mignogna C, Buzzetti R. Adult-onset autoimmune diabetes in 2020: An update. Maturitas 2020; 137:37-44. [DOI: 10.1016/j.maturitas.2020.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 12/11/2022]
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Jörns A, Wedekind D, Jähne J, Lenzen S. Pancreas Pathology of Latent Autoimmune Diabetes in Adults (LADA) in Patients and in a LADA Rat Model Compared With Type 1 Diabetes. Diabetes 2020; 69:624-633. [PMID: 31974139 DOI: 10.2337/db19-0865] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/11/2020] [Indexed: 11/13/2022]
Abstract
Approximately 10% of patients with type 2 diabetes suffer from latent autoimmune diabetes in adults (LADA). This study provides a systematic assessment of the pathology of the endocrine pancreas of patients with LADA and for comparison in a first rat model mimicking the characteristics of patients with LADA. Islets in human and rat pancreases were analyzed by immunohistochemistry for immune cell infiltrate composition, by in situ RT-PCR and quantitative real-time PCR of laser microdissected islets for gene expression of proinflammatory cytokines, the proliferation marker proliferating cell nuclear antigen (PCNA), the anti-inflammatory cytokine interleukin (IL) 10, and the apoptosis markers caspase 3 and TUNEL as well as insulin. Human and rat LADA pancreases showed differences in areas of the pancreas with respect to immune cell infiltration and a changed ratio between the number of macrophages and CD8 T cells toward macrophages in the islet infiltrate. Gene expression analyses revealed a changed ratio due to an increase of IL-1β and a decrease of tumor necrosis factor-α. IL-10, PCNA, and insulin expression were increased in the LADA situation, whereas caspase 3 gene expression was reduced. The analyses into the underlying pathology in human as well as rat LADA pancreases provided identical results, allowing the conclusion that LADA is a milder form of autoimmune diabetes in patients of an advanced age.
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Affiliation(s)
- Anne Jörns
- Institute of Clinical Biochemistry, Hannover Medical School, Hannover, Germany
| | - Dirk Wedekind
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - Joachim Jähne
- Department of General and Visceral Surgery, Diakovere, Henriettenstift, Hannover, Germany
| | - Sigurd Lenzen
- Institute of Clinical Biochemistry, Hannover Medical School, Hannover, Germany
- Institute of Experimental Diabetes Research, Hannover Medical School, Hannover, Germany
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Issar T, Yan A, Kwai NCG, Poynten AM, Borire AA, Arnold R, Krishnan AV. Altered peripheral nerve structure and function in latent autoimmune diabetes in adults. Diabetes Metab Res Rev 2020; 36:e3260. [PMID: 31833206 DOI: 10.1002/dmrr.3260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/14/2019] [Accepted: 11/27/2019] [Indexed: 11/07/2022]
Abstract
AIM The present study was undertaken to investigate mechanisms of peripheral nerve dysfunction in latent autoimmune diabetes in adults (LADA). MATERIALS AND METHODS Participants with LADA (n = 15) underwent median nerve ultrasonography and nerve excitability to examine axonal structure and function, in comparison to cohorts of type 1 diabetes (n = 15), type 2 diabetes (n = 23) and healthy controls (n = 26). The LADA group was matched for diabetes duration, glycaemic control, and neuropathy severity with the type 1 and type 2 diabetes groups. A validated mathematical model of the human axon was utilized to investigate the pathophysiological basis of nerve dysfunction. RESULTS The most severe changes in nerve structure and function were noted in the LADA group. The LADA cohort demonstrated a significant increase in nerve cross-sectional area compared to type 1 participants and controls. Compared to type 1 and 2 diabetes, measures of threshold electrotonus, which assesses nodal and internodal conductances, were significantly worse in LADA in response to both depolarising currents and hyperpolarising currents. In the recovery cycle, participants with LADA had a significant increase in the relative refractory period. Mathematical modelling of excitability recordings indicated the basis of nerve dysfunction in LADA was different to type 1 and 2 diabetes. CONCLUSIONS Participants with LADA exhibited more severe changes in nerve function and different underlying pathophysiological mechanisms compared to participants with type 1 or 2 diabetes. Intensive management of risk factors to delay the progression of neuropathy in LADA may be required.
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Affiliation(s)
- Tushar Issar
- Prince of Wales Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - Aimy Yan
- Prince of Wales Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - Natalie C G Kwai
- Prince of Wales Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Exercise Physiology, UNSW Sydney, Sydney, New South Wales, Australia
| | - Ann M Poynten
- Department of Endocrinology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Adeniyi A Borire
- Prince of Wales Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - Ria Arnold
- Department of Exercise Physiology, UNSW Sydney, Sydney, New South Wales, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
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Lee YY, Lin CW, Chen IW. Exogenous Insulin Injection-Induced Stiff-Person Syndrome in a Patient With Latent Autoimmune Diabetes: A Case Report and Literature Review. Front Endocrinol (Lausanne) 2020; 11:594. [PMID: 32982980 PMCID: PMC7492528 DOI: 10.3389/fendo.2020.00594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/21/2020] [Indexed: 01/21/2023] Open
Abstract
Stiff-person syndrome (SPS) is highly associated with anti-glutamic acid decarboxylase (GAD) antibody. However, GAD antibodies alone appear to be insufficient to cause SPS, and they possibly are involved in only part of its pathophysiology. It is suspected that the symptoms of SPS get precipitated by external stimuli. Here, we briefly introduce the case of a patient with latent autoimmune diabetes who developed SPS through the action of subcutaneously injected insulin. A 43-year-old man was diagnosed with diabetes and initially well-controlled with oral hypoglycemic agents but progressed to requiring insulin within 1 year of diagnosis. Two months after the initiation of basal insulin therapy, he presented with abdominal stiffness and painful muscle spasms, involving the lower limbs, which resulted in walking difficulty, and thus, he refused insulin injections thereafter. He had been treated with oral anti-diabetic agents instead of insulin for 10 years until premixed insulin twice daily was started again due to poor diabetes control. Immediately after insulin injection, abdominal muscle rigidity and spasms were noted. When insulin was not administered, frequent episodes of diabetic ketoacidosis occurred. Serum GAD antibody test was positive and there was no positivity for islet antigen-2 antibody. A glucagon stimulation test demonstrated relative insulin deficiency, indicative of latent autoimmune diabetes in adults (LADA). Tolerable muscle rigidity was achieved when the dosage of basal insulin was split into two separate daily injections with lower amounts of units per injection. This case highlights a different form of autoimmune diabetes in SPS. To our knowledge, this is the first report of SPS described shortly after the initiation of insulin therapy that required basal insulin to achieve tolerable muscle symptoms and better glucose control, without the development of diabetic ketoacidosis.
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Liu B, Xiang Y, Liu Z, Zhou Z. Past, present and future of latent autoimmune diabetes in adults. Diabetes Metab Res Rev 2020; 36:e3205. [PMID: 31318117 DOI: 10.1002/dmrr.3205] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/14/2019] [Accepted: 07/11/2019] [Indexed: 12/14/2022]
Abstract
Latent autoimmune diabetes in adults (LADA) is the most common form of autoimmune diabetes diagnosed in adults. Similar to type 1 diabetes, the prevalence of LADA is impacted by ethnicity and geography. LADA is characterized by β cell loss due to autoimmunity and insulin resistance and has highly heterogeneous clinical features, autoimmunity, and genetics in a glutamic acid decarboxylase antibody (GADA) titre-dependent manner, suggesting LADA is part of a continuum spectrum between type 1 and type 2 diabetes. Although LADA is the most frequent form of autoimmune diabetes diagnosed in adults, clinical trials involving LADA are scarce. Here we review the recent advancements in LADA epidemiology, clinical features, pathogenesis, and interventions. We also highlight the environmental factors that are thought to play an important role in addition to genetics in the pathogenesis of LADA. In the future, high-throughput molecular profiles might shed light on the nature of LADA among the wide spectrum of diabetes and offer new opportunities to identify novel LADA-specific biomarkers.
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Affiliation(s)
- Bingwen Liu
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, Central South University, Changsha, China
| | - Yufei Xiang
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, Central South University, Changsha, China
| | - Zhenqi Liu
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA
| | - Zhiguang Zhou
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, Central South University, Changsha, China
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Rahmadi A, Decroli E, Kam A. Sepsis in Latent Autoimmune Diabetes in Adults with Diabetic Ketoacidosis: A Case Report. Open Access Maced J Med Sci 2019; 7:3501-3504. [PMID: 32002083 PMCID: PMC6980811 DOI: 10.3889/oamjms.2019.687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This case report intends to highlight the challenge in diagnosing type 1 diabetes on an adult patient. Latent Autoimmune Diabetes in Adult (LADA) types I diabetes Mellitus, which found in adulthood and characterised by progressive damage to pancreatic β cells that happened slowly. Incidence of LADA is around 2-12% of the total diabetes population. Sepsis in LADA patients will trigger diabetic ketoacidosis (DKA). CASE REPORT We report a case of a 33-year-old woman patient presents with decreased consciousness accompanied by rapid and deep breathlessness for 1 day. Before, the patient complains of fever and cough. Physical examination found soporous, blood pressure 120/80 mmHg, pulse 110 x/minute, temperature 38.8°C, breathing 32 x/minute Kussmaul. Bronchovesicular breath crackles in both lower lung fields. leukocytes were 22,100/mm3, random blood glucose 638 mg/dL, urine ketone +++, HbA1C 17.2%, HOMA IR less than 2 units. C-peptide 0.3 ng/mL and GADAs 16.9 U/mL. Chest Xray indicated bronchopneumonia. Patients were diagnosed with diabetic ketoacidosis, LADA, and sepsis caused by bronchopneumonia. Patient treated with DKA management and sepsis. On the second day, the treatment of DKA was resolved and continued with the administration of short-acting insulin and regular long-acting. CONCLUSION Sepsis in LADA with DKA requires fast and appropriate management. Further search is needed to diagnose LADA.
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Affiliation(s)
- Afdol Rahmadi
- Department of Internal Medicine, Faculty of Medicine, Andalas University, M. Djamil General Hospital, Padang, Sumatera Barat, Indonesia
| | - Eva Decroli
- Department of Internal Medicine, Faculty of Medicine, Andalas University, M. Djamil General Hospital, Padang, Sumatera Barat, Indonesia
| | - Alexander Kam
- Department of Internal Medicine, Faculty of Medicine, Andalas University, M. Djamil General Hospital, Padang, Sumatera Barat, Indonesia
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Hals IK, Fiskvik Fleiner H, Reimers N, Astor MC, Filipsson K, Ma Z, Grill V, Björklund A. Investigating optimal β-cell-preserving treatment in latent autoimmune diabetes in adults: Results from a 21-month randomized trial. Diabetes Obes Metab 2019; 21:2219-2227. [PMID: 31148332 DOI: 10.1111/dom.13797] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 12/25/2022]
Abstract
AIMS To compare outcomes of glucagon-stimulated C-peptide tests (GSCTs) in people with latent autoimmune diabetes in adults (LADA) after a 21-month intervention with either insulin or the dipeptidyl peptidase-4 inhibitor sitagliptin. RESEARCH DESIGN AND METHODS We included 64 glutamic acid decarboxylase (GAD) antibody-positive individuals, who were diagnosed with diabetes <3 years before the study, aged 30 to 70 years, and without clinical need for insulin treatment. We stratified participants by age and body mass index (BMI) and evaluated β-cell function by GSCT after a 48-hour temporary withdrawal of study medication. RESULTS Age at randomization (mean 53 years), BMI (mean 27 kg/m2 ) and metabolic markers were similar between treatment arms. Glycated haemoglobin concentrations during intervention did not differ between arms. Fasting C-peptide concentrations after the intervention were similar, as were stimulated C-peptide levels (0.82 ± 0.63 nmol/L after insulin, 0.82 ± 0.46 nmol/L after sitagliptin; nonsignificant). Autoimmunity in the study population (estimated from GAD antibody titres and positivity/no positivity for zinc transporter 8 and islet antigen 2 antibodies) affected the evolution of the GSCT results significantly, which deteriorated in participants with high but not in those with low autoimmunity. Adjustment using analysis of covariance for the degree of autoimmunity did not alter the findings of no difference between treatment arms. CONCLUSIONS β-cell function after intervention was similar in patients with insulin- and sitagliptin-treated LADA, regardless of the strength of autoimmunity. Further, participants with low levels of GAD antibodies did not experience progressive deterioration of β-cell function over a 21-month period. Taken together, these findings could be useful for clinicians' choices of treatment in people with LADA.
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Affiliation(s)
- Ingrid K Hals
- Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Hanne Fiskvik Fleiner
- Department of Clinical Pharmacology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Nina Reimers
- Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marianne C Astor
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Karin Filipsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Zuheng Ma
- Department of Molecular Medicine and Surgery, Endocrine and Diabetes Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Valdemar Grill
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anneli Björklund
- Department of Molecular Medicine and Surgery, Endocrine and Diabetes Unit, Karolinska University Hospital, Stockholm, Sweden
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Yohena S, Penas-Steinhardt A, Muller C, Faccinetti NI, Cerrone GE, Lovecchio S, Ridner E, Valdez S, Frechtel G. Immunological and clinical characteristics of latent autoimmune diabetes in the elderly. Diabetes Metab Res Rev 2019; 35:e3137. [PMID: 30743316 DOI: 10.1002/dmrr.3137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Latent autoimmune diabetes in adults (LADA) is determined by both a noninsulin-dependent clinical presentation and an autoimmune pathogenic process. Glutamic acid decarboxylase antibody (GADA) constitutes the most important marker, although IA-2A and ZnT8A also define LADA presentation. Type 2 diabetes mellitus (T2DM) is the most prevalent type particularly over 65 years old. Studies about autoimmunity in this age group are scarce. OBJECTIVE The aim of this work was to determine whether three autoantibodies for diabetes autoimmunity were present in elderly T2DM patients, and to assess the distinctive clinical features of autoantibody-positive patients. RESEARCH DESIGN AND METHODS We recruited 153 patients with diabetes with onset of diabetes after 65 years of age and a BMI under 30 kg/m2 . RESULTS The prevalence of at least one of the autoantibodies was 15.68% (24/153). The most prevalent autoantibody was GADA with 8.49% (13/153), followed by ZnT8A with 6.50% (10/153) and IA2A with 1.96% (3/153). The autoimmunity-positive group presented higher HbA1c (7.01 ± 1.98 vs 6.35 ± 1.01; P = 0.007) and more prevalent insulin therapy (25% vs 10.85%; P = 0.047). GADA-positive patients with diabetes presented higher FPG (7.79 ± 3.79 mmol/L vs 6.43 ± 1.6 mmol/L; P = 0.014) and insulin therapy more frequently (46% vs 10.71%; p = 0.015). GADA titre levels in the individuals with BMI under 27 kg/m2 were higher (35.00 ± 4.20) than those in the group with BMI over 27 kg/m2 (8.83 ± 3.041; P = 0.0005). CONCLUSION Autoantibodies GADA and Znt8A may be useful markers in identifying a subgroup of older patients with a clinical presentation of diabetes which could be characterized as latent autoimmune diabetes in the elderly.
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Affiliation(s)
- Silvina Yohena
- Sirio Libanés Hospital, Buenos Aires, Argentina
- University Institute of Health Sciences, Barcelo Foundation, Buenos Aires, Argentina
| | - Alberto Penas-Steinhardt
- University Institute of Health Sciences, Barcelo Foundation, Buenos Aires, Argentina
- National University of Luján, Department of Basic Sciences, Computational Genomics Laboratory, Luján, Buenos Aires, Argentina
| | | | - Natalia I Faccinetti
- Chair of Immunology, Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
| | - Gloria E Cerrone
- Institute of Immunology, Genetics and Metabolism, Clinical Hospital and Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
- Chair of Genetics, Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
| | - Silvia Lovecchio
- Sirio Libanés Hospital, Buenos Aires, Argentina
- University Institute of Health Sciences, Barcelo Foundation, Buenos Aires, Argentina
| | - Edgardo Ridner
- University Institute of Health Sciences, Barcelo Foundation, Buenos Aires, Argentina
| | - Silvina Valdez
- Chair of Immunology, Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
| | - Gustavo Frechtel
- Sirio Libanés Hospital, Buenos Aires, Argentina
- University Institute of Health Sciences, Barcelo Foundation, Buenos Aires, Argentina
- Institute of Immunology, Genetics and Metabolism, Clinical Hospital and Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
- Chair of Genetics, Faculty of Pharmacy and Biochemistry, Buenos Aires University, Buenos Aires, Argentina
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Nishimura A, Matsumura K, Kikuno S, Nagasawa K, Okubo M, Mori Y, Kobayashi T. Slowly Progressive Type 1 Diabetes Mellitus: Current Knowledge And Future Perspectives. Diabetes Metab Syndr Obes 2019; 12:2461-2477. [PMID: 31819572 PMCID: PMC6886592 DOI: 10.2147/dmso.s191007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/18/2019] [Indexed: 12/21/2022] Open
Abstract
Slowly progressive type 1 insulin-dependent diabetes mellitus (SPIDDM), sometimes referred to as latent autoimmune diabetes in adults (LADA), is a heterogeneous disease that is often confused with type 1 and type 2 diabetes. As a result, there were few diagnostic criteria for this disorder until 2012, when the Japan Diabetes Society established criteria that could be used in clinical practice. A primary question is whether pathologic markers for type 1 or type 2 diabetes are present in the pancreas of patients with SPIDDM, because the phenotype of SPIDDM is similar to both type 1 and type 2 diabetes. Recent studies clarified pathologic findings in the pancreas of patients with SPIDDM, which included T-cell-mediated insulitis, a marker of type 1 diabetes; pseudoatrophic islets (islets specifically devoid of beta cells), another hallmark of type 1 diabetes; and a lack of amylin (ie, islet amyloid polypeptide) deposition to the islet cells, a pathologic marker of type 2 diabetes. In terms of preventing the loss of beta-cell function in patients with SPIDDM, several studies have shown that some drugs, including dipeptidyl peptidase-4 inhibitors, are effective. There is an increased need for early diagnosis of SPIDDM to preserve beta-cell function. This review presents updated findings on the pathogenesis and immunologic findings of the affected pancreas, diagnostic markers, risk factors for progression of beta-cell dysfunction, epidemiology, clinical features, diagnostic strategies, prevention strategies, and clinical options for patients with SPIDDM.
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Affiliation(s)
- Akihiro Nishimura
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Kimio Matsumura
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Shota Kikuno
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Kaoru Nagasawa
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Minoru Okubo
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Yasumichi Mori
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Tetsuro Kobayashi
- Division of Immunology and Molecular Medicine, Okinaka Memorial Institute for Medical Research, Tokyo, Japan
- Correspondence: Tetsuro Kobayashi Okinaka Memorial Institute for Medical Research, 2-2-2 Toranomon, Minato-Ku, Tokyo, JapanTel +81-3-3588-1111Fax +81-3-3582-7068 Email
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