stiinte med 3 2011.indd - Academia de Ştiinţe a Moldovei

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cemiei bazale şi ale HbA1c, comparativ cu LADA 2.
Rezultate similare au fost descrise şi în studiul Ungar
condus de Hosszufalusi N. (2003) [6].
Concluzii. În baza celor expuse anterior, se poate
concluziona că diabetul autoimun la maturi se poate
manifesta ca diabet de tip I, cu o evoluţie clasică, şi
prin forma LADA, care are un debut mai lent. Diagnosticul
de diabet autoimun este necesar de stabilit
nu doar numai prin prezenţa semnelor clinice şi
paraclinice specifice diabetului de tip 1, dar şi prin
confirmări imunologice de apreciere a autoanticorpilor
printre pacienţii cu diabet zaharat de tip II aparent
cu debut la maturi tineri.
Bibliografie selectivă
1. Carlsson A. et al. Insulin and glucagon secretion
in patients with LADA diabetes. In: J. Clin. Endocrinol.
Metabol., 2000, vol 85, p. 76 -80.
2. David R. et al. Type 1 diabetes and latent autoimmune
diabetes in adults one end of the rainbow. In: J. Clin.
End. Met. 2005, vol. 91, no. 5, p. 1654-1659.
3. Davis T., Zimmet P., Davis W., Bruce D. et al.
Autoantibodies to glutamic acid decarboxylase in diabetic
patients from a multi-etnic Australian community: the
Fremantle Diabetes Study. In: Diabetes Med., 2000, vol.
17, p. 667–674.
4. Defi nition, diagnosis and classifi cation of diabetes
mellitus and its complications. Report of a WHO Consultation,
1999.
5. Gottsater A. et al. Islet cell antibodies are associated
with β-cell failure also in obese adult onset diabetic
patients. In: Acta Diabetologica, 1994, 31, p. 226 – 231.
6. Hosszufalusi N., Vatay A., et al. Similar genetic
features and different islet cell autoantibody pattern of
LADA compared with adult-onset type 1 diabetes with rapid
progression. In: Diabetes Care, 2003, vol. 26, N 2, p.
452- 457.
7. Ionescu-Tîrgovişte C. Diabetologie Modernă.
Editura Tehnică, Bucureşti, 2010.
8. Lohmann T., Nietzschmann U., Kiess W. et al.
„Lady-like” is there a latent autoimmune diabetes in the
young? In: Diab. Care, 1999, vol. 23, p. 1707–1708.
9. Leslie R., Pozzilli P., Type 1 diabetes masquerading
as type 2 diabetes. Diab. Care, 1994, vol. 17, p.1214–
1219.
10. Molbak A.G., Christau B. et al. Incidence of insulino-dependent
diabetes mellitus in age groups over 30
years in Denmark. Diab. Med. 1994, vol. 11, p 650–655.
11. Pozzilli P., Di Mario U., Autoimmune diabetes
not requiring insulin at diagnosis (latent autoimmune diabetes
of the adult): defi nition, characterization, and potential
prevention. Diabetes Care, 2001, vol. 24, p. 1460–
1467.
12. Turner R., Stratton I. et al. UKPDS 25: autoantibodies
to islet-cell cytoplasm and glutamic acid decarboxylase
for prediction of insulin requirrement in type 2
diabetes. Lancet, 350, 1288–1293, 1997.
13. Weslley P., Souza R., et al., Comparison of cli-
Buletinul AŞM
nical and laboratory characteristics between adult-onset
type 1 diabetes and latent autoimmune diabetes in adults.
Diabetes Care vol. 28, p. 1803–1804, 2005.
14. Zimmet P.., Turner R., McCarty D. et al., Crucial
points at diagnosis: type 2 diabetes or slow type 1 diabetes.
Diabetes Care, 1999, vol. 22, p. 59-64.
Rezumat
Diabetul zaharat de tip 1 este o patologie autoimună,
care determină destrucţia celulelor ß-pancreatice. O parte
din persoanele adulte care au modificări imunologice specifice
diabetului autoimun nu necesită administrarea insulinei.
Debutul la un astfel de tip de diabet este la o vârstă
adultă, şi deoarece iniţial nu necesită insulinoterapie, acesta
este specificat ca un diabet de tip 2. În acest caz se stabileşte
diagnosticul de LADA (Latent Autoimmune Diabetes
of the Adult). O atenţie deosebită se cere acordată acestei
forme de diabet, deoarece tratamentul adecvat al acesteia
ar putea influenţa viteza progresării insulinodependenţei şi
ar proteja secreţia de C-peptid.
Summary
Type 1 diabetes is caused by the immune-mediated
destruction of pancreatic β-cells. A fraction of individuals
with humoral immunological changes have clinical diabetes
that initially is not insulin-requiring. The onset of diabetes
is usually in adult life, and because their diabetes is at least
initially not insulin-requiring, they appear clinically to
be affected by type 2. These patients are defined as being
affected by an autoimmune type of diabetes not requiring
insulin at diagnosis, which is also named latent autoimmune
diabetes of the adult. Special attention should be paid to
diagnose such patients because therapy may influence the
speed of progression toward insulin dependency, and in
this respect, efforts should be made to protect C-peptide
secretion.
Резюме
Сахарный диабет 1-го типа – это заболевание,
в основе которого лежит аутоиммунная деструкция
β-клеток, приводящая к абсолютному дефициту инсулина.
В популяции больных сахарным диабетом существует
группа пациентов с генетическими и иммунологическими
маркёрами, характерными для сахарного
диабета 1 типа, которая с точки зрения клининческих
проявлений часто не нуждается в назначении инсулина
при первичном выявлении заболевания. Таких пациентов
часто относят к СД 2 типа. Было предложено новое
название для этого подтипа СД – латентный аутоиммунный
диабет взрослых. Принимая во внимание аутоиммунный
патогенез LADA, необходимо отметить, что
раннее назначение инсулина данной группе пациентов
имеет значенение не только в нормализации метаболизма
жиров и углеводов, но и в реализации защитного
эффекта против аутоиммуного поражения β клеток
поджелудочной железы.