scholarly journals The role of “latent autoimmune diabetes in adults” in the structure of diabetes mellitus in young people

2022 ◽  
pp. 150-155
Author(s):  
A. K. Ovsyannikova ◽  
R. B. Galenok ◽  
O. B. Rymar

In the clinical practice of an endocrinologist, verification of the type of diabetes mellitus (DM) in young people is of high clinical significance, since the prescription of treatment depends on this: from the correction of carbohydrate metabolism by a balanced diet to the prescription of oral hypoglycemic drugs and insulin therapy. In rare forms of diabetes mellitus, which include «latent autoimmune diabetes in adults» (LADA), it is not always possible to make a correct diagnosis. This form of diabetes mellitus occupies an intermediate position between type 1 diabetes mellitus and type 2 diabetes mellitus (DM 1 and DM 2) and is often not detected. In this regard, the study of the LADA flow is of great practical importance. Verification of the LADA diagnosis is based on three clinical criteria: adult onset of diabetes; the presence of circulating islet autoantibodies, which distinguishes LADA from T2DM; the absence of an absolute need for insulin when making a diagnosis, which distinguishes LADA from the classic type 1 diabetes mellitus. The main treatment tactics for patients with LADA should be aimed at preserving their own insulin secretion. This requires the timely appointment of insulin therapy. The question of the possibility of using drugs of peripheral action – biguanides and glitazones, which do not cause depletion of β-cells, is discussed, but their effectiveness has not yet been established. The appointment of any secretogens, including sulfonylurea preparations, is contraindicated Quite often, LADA is difficult to diagnose, and the wrong treatment tactics are prescribed. At the moment, there is little data on the effectiveness of different classes of drugs, which leads to further detailed study of this type of diabetes. Currently, there are no special algorithms for LADA treatment

2021 ◽  
Vol 24 (1) ◽  
pp. 70-73
Author(s):  
M. R. Ragimov ◽  
D. D. Omelchuk ◽  
L. I. Ibragimova ◽  
O. S. Derevyanko ◽  
T. V. Nikonova

Slowly developing immune-mediated diabetes, often called latent autoimmune diabetes in adults, is characterized by the presence of autoantibodies (ATs) to glutamic acid decarboxylase (GADA), the patient's age at the onset over 35 years, and the absence of the need for insulin therapy for 6-12 months to 6 years from the moment of diagnosis, according to the WHO classification of 2019, refers to hybrid forms of diabetes mellitus (DM). In this article, we present a case history of slowly developing immune-mediated diabetes in a 14-year-old boy who was transferred from metformin monotherapy and a diet with restriction of digestible carbohydrates to the intensified insulin therapy only 4 years after the onset of diabetes mellitus with a glycated hemoglobin (HbA1c) level of less than 6.5% throughout the disease. As a result of the studies, the patient was found to have a homozygous genotype highly predisposing to the development of Type 1 Diabetes Mellitus (T1DM), as well as increased levels of ATs to GADA and tyrosine phosphatase (IA-2A). The initially preserved level of basal C-peptide and the clinical course of the disease in this patient do not allow us to classify this case as a classic variant of the course of Type 1 Diabetes Mellitus.


2002 ◽  
Vol 84 (2) ◽  
pp. 109-115 ◽  
Author(s):  
Ágnes Vatay ◽  
Katalin Rajczy ◽  
Éva Pozsonyi ◽  
Nóra Hosszúfalusi ◽  
Zoltán Prohászka ◽  
...  

2020 ◽  
Vol 29 ◽  
Author(s):  
Rebecca Ortiz La Banca ◽  
Valéria de Cássia Sparapani ◽  
Mariana Bueno ◽  
Taine Costa ◽  
Emilia Campos de Carvalho ◽  
...  

ABSTRACT Objective: to identify evidence available in the literature on educational strategies used in the teaching of insulin therapy to children and adolescents with Type 1 diabetes mellitus. Method: systematic review undertaken in five databases, using the descriptors Insulin/therapeutic use, Patient education as topic, Diabetes mellitus type 1, Child, Infant, Adolescent and keywords, without any time limit. Primary studies on insulin therapy teaching were included, while research on insulin pumps was excluded. Results: 243 studies were identified, 13 of which were included. The results present educational strategies focused on children, adolescents and young people of up to 24 years of age, applied individually or in groups; by telephone contact or text messages by mobile phone; dramatization and educational camps; by a single professional or a multidisciplinary team. The strategies described in the analyzed studies addressed the adjustment of insulin dosages in everyday situations and education for insulin management, associated with the nutritional strategy of carbohydrate counting, diabetes education with a specific module on insulin therapy and intensive insulin use. The studies analyzed the effect of the educational intervention on several clinical and behavioral outcomes, such as glycated hemoglobin and self-efficacy. Conclusion: this review could not identify a single educational strategy able to improve metabolic and psychosocial outcomes. In most cases, nurses are the professionals responsible for the development of educational strategies focused on insulin therapy in children and adolescents with diabetes, regardless of the context in which they will be deployed. This confirms their role as educators.


2014 ◽  
Vol 13 (1) ◽  
pp. 73-78
Author(s):  
T. V. Saprina ◽  
T. S. Prokhorenko ◽  
F. E. Lazarenko ◽  
I. N. Vorozhtsova ◽  
N. V. Ryazantseva

Some researchers found that the development of microvascular complications (nephropathy, retinopathy) with latent autoimmune diabetes adults (LADA) occurs much earlier than in type 1 diabetes mellitus. The research devoted to the study of the spectrum and the time of development of microangiopathy in patients with latent autoimmune diabetes of adults, compared to patients with type 1 and 2 diabetes mellitus. Also studied immunological factors (cytokine secretion of mononuclear leukocytes) as one of the possible mechanisms of diabetic angiopathy progression. It has been shown that in LADA, as in patients with type 2 diabetes mellitus, the development of microvascular complications (nephropathy, retinopathy) occurs much earlier than in type 1 diabetes mellitus (after a 4-year course of the disease) due to a sharp decline in the serum concentration of C peptide. Thus in patients with LADA, having microvascular complications in the supernatants of cell cultures of mononuclear leukocytes determined a significant increase in the concentrations of cytokines IL-2, IL-4, TNFα.


Author(s):  
Isabel Borges ◽  
Roberto Añez ◽  
Mervin Chavez-Castillo ◽  
Juan Salazar

Adult-onset autoimmune diabetes (AOAD) is clinical form of diabetes with a wide spectrum of genotypical and phenotypical manifestations, which has risen in prominence in recent decades, probably due to greater interest in its pathogenic mechanisms, and increased identification of autoimmune markers. The clinical presentation may vary from type 1 diabetes mellitus to latent autoimmune diabetes in adults, which although clearly distinct from a theoretical viewpoint, may pose various clinical pitfalls in practice. We present the case of a patient with AOAD which featured several diagnostic challenges during follow-up.


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