В настоящее время широко изучается один из вариантов течения аутоиммунного сахарного диабета – медленно прогрессирующий аутоиммунный диабет взрослых (латентный аутоимунный диабет взрослых – latent autoimmune diabetes of adults, LADA). Он сопровождается нетипичной клинической картиной как для классического сахарного диабета типа 1, так и для типа 2. Несмотря на наличие положительных аутоантител, LADA характеризуется медленными темпами аутоиммунной деструкции, в связи с чем потребность в инсулинотерапии возникает не сразу. В предлагаемой статье мы попытались разобраться, к какому типу сахарного диабета по своему течению LADA ближе. Также освещается роль самоконтроля гликемии у пациентов с LADA.
Currently, one of the variants of the current autoimmune diabetes mellitus is widely studied – it is a slowly progressing autoimmune diabetes of adults (latent autoimmune diabetes of adults, LADA). It is accompanied by an atypical clinical picture for both classical type 1 diabetes mellitus and type 2. Despite the presence of positive autoantibodies, LADA is characterized by a slow rate of autoimmune destruction, and therefore the need for insulin therapy does not appear immediately. In the proposed article, we tried to figure out which type of sugar diabetes by its course LADA is closer. Also, the role of self-monitoring of glycemia in patients with LADA is highlighted.
Key words: latent autoimmune diabetes of adults, self-control of glycemia, diabetes mellitus, glucometer.
1. Глобальный доклад по диабету ВОЗ, 2016. / Global'nyi doklad po diabetu VOZ, 2016. [in Russian]
2. Landin-Olsson M. Latent autoimmune diabetes in adults. Ann NY Acad Sci 2002; 958: 112–6.
3. Leslie RD, Williams R, Pozzilli P. Clinical review: Type 1 diabetes and latent autoimmune diabetes in adults: one end of the rainbow. J Clin Endocrinol Metab 2006; 91 (5): 1654–9.
4. Tuomi T, Groop L, Zimmet PZ, Merrill J et al. Antibodies to glutamic acid decarboxylase reveal latent autoimmune diabetes mellitus in adults with a non-insulin-dependent onset of disease. Diabetes 1993; 42: 359–62.
5. Tuomi T, Zimmet P, Mackay IR et al. Latent Autoimmune Diabetes Mellitus in Adults (LADA): the Role of Antibodies to Glutamic Acid Decarboxylase in Diagnosis and Prediction of Insulin Dependency. Diabetes 1994; 11: 299–303.
6. Zimmet PZ. The pathogenesis and prevention of diabetes in adults: genes, autoimmunity, and demography. Diabetes Care 1995; 18: 1050–64.
7. Fourlanos S, Perry C, Stein MS et al. A clinical screening tool identifies autoimmune diabetes in adults. Diabetes Care 2006; 29 (5): 970–5.
8. Behme MT, Dupre J, Harris SB et al. Insulin resistance in latent autoimmune diabetes of adulthood. Ann NY Acad Sci 2003; 1005: 374–7.
9. Carlsson S, Midthjell K, Tesfamarian M.Y et al. Age, overweight and physical inactivity increase the risk of latent autoimmune diabetes in adults: results from the Nord-Trоndelag health study. Diabetologia 2007; 50 (1): 55–8.
10. Nambam B, Aggarwal S, Jain A. Latent autoimmune diabetes in adults: A distinct but heterogeneous clinical entity. World J Diabetes 2010; 1 (4): 111–5.
11. Thunander M, Thorgeirsson H, Törn C et al. b-cell function and metabolic control in latent autoimmune diabetes in adults with early insulin versus conventional treatment: a 3-year follow-up. Eur J Endocrinol 2011; 164 (2): 239–45.
12. Maruyama T, Shimada A, Kanatsuka A et al. Multicenter prevention trial of slowly progressive type 1 diabetes with small dose of insulin (the Tokyo study): preliminary report. Ann N Y Acad Sci 2003; 1005: 362–9.
13. Takino H, Yamasaki H, Sera Y et al. The preliminary report from the nation-wide prevention study for type 1 diabetes initially diagnosed as type 2 in Japan. Diabetes Metab Rev 1998; 14: 334–5.
14. Kobayashi T, Nakanishi K, Murase T, Kosaka K. Small doses of subcutaneous insulin as a strategy for preventing slowly progressive beta-cell failure in islet cell antibody-positive patients with clinical features of NIDDM. Diabetes 1996; 45: 622–6.
15. Алгоритмы специализированной медицинской помощи больных сахарным диабетом. Под ред. И.И.Дедова, М.В.Шестаковой. Вып. 8. М., 2017. / Algoritmy spetsializirovannoi meditsinskoi pomoshchi bol'nykh sakharnym diabetom. Pod red. I.I.Dedova, M.V.Shestakovoi. Vyp. 8. M., 2017. [in Russian]
16. Caswell M et al. Accuracy and User Performance Evaluation of a Blood Glucose Monitoring System. Diabetes Technol Ther 2015; 3: 1–7.
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1. Global'nyi doklad po diabetu VOZ, 2016. [in Russian]
2. Landin-Olsson M. Latent autoimmune diabetes in adults. Ann NY Acad Sci 2002; 958: 112–6.
3. Leslie RD, Williams R, Pozzilli P. Clinical review: Type 1 diabetes and latent autoimmune diabetes in adults: one end of the rainbow. J Clin Endocrinol Metab 2006; 91 (5): 1654–9.
4. Tuomi T, Groop L, Zimmet PZ, Merrill J et al. Antibodies to glutamic acid decarboxylase reveal latent autoimmune diabetes mellitus in adults with a non-insulin-dependent onset of disease. Diabetes 1993; 42: 359–62.
5. Tuomi T, Zimmet P, Mackay IR et al. Latent Autoimmune Diabetes Mellitus in Adults (LADA): the Role of Antibodies to Glutamic Acid Decarboxylase in Diagnosis and Prediction of Insulin Dependency. Diabetes 1994; 11: 299–303.
6. Zimmet PZ. The pathogenesis and prevention of diabetes in adults: genes, autoimmunity, and demography. Diabetes Care 1995; 18: 1050–64.
7. Fourlanos S, Perry C, Stein MS et al. A clinical screening tool identifies autoimmune diabetes in adults. Diabetes Care 2006; 29 (5): 970–5.
8. Behme MT, Dupre J, Harris SB et al. Insulin resistance in latent autoimmune diabetes of adulthood. Ann NY Acad Sci 2003; 1005: 374–7.
9. Carlsson S, Midthjell K, Tesfamarian M.Y et al. Age, overweight and physical inactivity increase the risk of latent autoimmune diabetes in adults: results from the Nord-Trоndelag health study. Diabetologia 2007; 50 (1): 55–8.
10. Nambam B, Aggarwal S, Jain A. Latent autoimmune diabetes in adults: A distinct but heterogeneous clinical entity. World J Diabetes 2010; 1 (4): 111–5.
11. Thunander M, Thorgeirsson H, Törn C et al. b-cell function and metabolic control in latent autoimmune diabetes in adults with early insulin versus conventional treatment: a 3-year follow-up. Eur J Endocrinol 2011; 164 (2): 239–45.
12. Maruyama T, Shimada A, Kanatsuka A et al. Multicenter prevention trial of slowly progressive type 1 diabetes with small dose of insulin (the Tokyo study): preliminary report. Ann N Y Acad Sci 2003; 1005: 362–9.
13. Takino H, Yamasaki H, Sera Y et al. The preliminary report from the nation-wide prevention study for type 1 diabetes initially diagnosed as type 2 in Japan. Diabetes Metab Rev 1998; 14: 334–5.
14. Kobayashi T, Nakanishi K, Murase T, Kosaka K. Small doses of subcutaneous insulin as a strategy for preventing slowly progressive beta-cell failure in islet cell antibody-positive patients with clinical features of NIDDM. Diabetes 1996; 45: 622–6.
15. Algoritmy spetsializirovannoi meditsinskoi pomoshchi bol'nykh sakharnym diabetom. Pod red. I.I.Dedova, M.V.Shestakovoi. Vyp. 8. M., 2017. [in Russian]
16. Caswell M et al. Accuracy and User Performance Evaluation of a Blood Glucose Monitoring System. Diabetes Technol Ther 2015; 3: 1–7.
Авторы
Н.Э.Хачатурян
ГБУЗ «Московский клинический научный центр им. А.С.Логинова» Департамента здравоохранения г. Москвы. 111123, Россия, Москва, ш. Энтузиастов, д. 86;
ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И.Евдокимова» Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1 nane18@list.ru
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N.E.Khachaturyan
A.S.Loginov Moscow Clinical Scientific Practical Center of the Department of Health of Moscow. 111123, Russian Federation, Moscow, sh. Entuziastov, d. 86;
A.I.Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1 nane18@list.ru