Functional state of β-cells, immunological and clinical-biochemical characteristics in patients with slowly progressive autoimmune diabetes in adults

Abstract

The paper deals with the diagnosis of latent autoimmune diabetes in adults (LADA). The study was undertaken to evaluate the functional activity of fi-cells, to define immunological and clinicobiochemical features in patients with LADA. Fifty-eight patients with the primary diagnosis of type 2 diabetes mellitus (DM). According to the results of the immunological study involving the determination of autoantibodies to cytoplasmic antigen (ICA), the isoform of glutamate decarboxylase with a molecular mass of 6500 (GAD), to insulin (IA), the patients were divided into 2 groups: 1) those with positive autoantibodies and 2) those with negative autoantibodies. In each group, the clinical and biochemical parameters, including the age at the onset of the disease, body-mass index, HbA_lc, the levels of cholesterol and triglycerides, the incidence of arterial hypertension, coronary heart disease, diabetic retinopathy, were analyzed. To evaluate the secretory function of ft-cells, 13 patients who had positive autoantibodies and a history of the disease of not more 5 years, and did not receive insulin performed an oral glucose tolerance test (OGTT) using 75 g of glucose; the levels of insulin and C-peptide were measured during the test. The findings have lead to the following conclusions:

1. Autoantibodies to GAD and ICA, rather than clinical and biochemical characteristics, are the main basic markers of latent autoimmune diabetes in adults.


2. Patients with LADA form a group at high risk for insulin uptake.


3. Decreased insulin secretion is revealed just in the first years of the disease when OGTT is carried out. With this, some patients have signs of the metabolic syndrome and, to all appearances, peripheral insulin resistance.