Slowly Progressive Type 1 Diabetes Mellitus: Current Knowledge And Future Perspectives

被引:33
作者
Nishimura, Akihiro [1 ]
Matsumura, Kimio [1 ]
Kikuno, Shota [1 ]
Nagasawa, Kaoru [1 ]
Okubo, Minoru [1 ]
Mori, Yasumichi [1 ]
Kobayashi, Tetsuro [2 ]
机构
[1] Toranomon Gen Hosp, Dept Endocrinol & Metab, Tokyo, Japan
[2] Okinaka Mem Inst Med Res, Div Immunol & Mol Med, Tokyo, Japan
基金
日本学术振兴会;
关键词
slowly progressive type 1 diabetes mellitus; SPIDDM; latent autoimmune diabetes in adults; LADA; insulitis; PanIN; GAD antibody; BETA-CELL FUNCTION; GLUTAMIC-ACID DECARBOXYLASE; C-PEPTIDE LEVELS; ADULTS LADA; CLINICAL CHARACTERISTICS; CHRONIC COMPLICATIONS; INSULIN REQUIREMENT; ISLET AUTOIMMUNITY; GLYCEMIC CONTROL; GENETIC-CHARACTERISTICS;
D O I
10.2147/DMSO.S191007
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:2461 / 2477
页数:17
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