The Analysis Of Clinical Characteristics Of Patients With Latent Autoimmune Diabetes In Adults

Background: Diabetes mellitus(DM) is a syndrome of impaired carbohydrate, fat, and protein metabolism caused by either lack of insulin secretion or decreased sensitivity of the tissues to insulin, and chronic blood glucose increased is the basic biochemical characteristic. The etiology and pathogenesis of DM is complex, both genetic and environmental factors involved in the development of DM. Depending on the different pathogenesis, DM can be divided into four types including type 1 diabetes mellitus(T1DM), type 2 diabetes mellitus(T2DM), gestational diabetes mellitus(GDM) and specific type of diabetes.The metabolic disorder syndrome is the main clinical feature of DM, affecting vascular lesion in both major blood vessel and micrangium,and finially causes multi-system damage. This research is mainly involves T1 DM, T2 DM and latent autoimmune diabetes in adults(LADA).The destruction of the islets leads to an absolute lack of insulin that characterizes T1 DM. T1 DM can be divided into autoimmune T1DM(1 a) and idiopathic T1DM(1 b) according to the pathological process. It can occur at any age and the major populations involved are teenagers. Most T1 DM patients develop in acute onset and the dramatic symptoms are polydipsia, polyphagia and polyuria. Ketoacidosis is more likely to occur if it couldn’t be diagnosed timely and treated promptly.T2DM manifests insulin resistance and insulin secretion defection. And it exhibits familial aggregation, consistent with variation in genetic susceptibility to the obesity. T2 DM mainly occurs in adults and it usually develops in chronic onset with mild symptoms, without ketosis tendency and independent of insulin supplement.The LADA is considered a slowly progressing subtype of T1 D, although the clinical features are more similar to T2 D. It can be easily misdiagnosis with T2 DM because the clinical features of LADA are similar with T2 D. Now the worldwide incidence of LADA is increased year by year. Increasing numbers of studies showed that LADA is similar with both T1 DM and T2 DM in the immune condition, genetic characteristic and clinical features, but with unique features.Objective: To obtain the incidence of LADA in newly diagnosed T2 DM in the Northeast in China, and to analyze the difference between LADA and T2 DM in clinical characteristics. These results will provide theoretical basis for the early diagnosis of LADA, and benefit for timely therapeutic intervention and precise therapies for LADA.Methods: Collecting 705 newly diagnosed T2 DM patients from August 1, 2013 to July 31, 2015 in treatment in the Secend Affiliated Hospital of Jilin University. Record the general information including gender, age, height, weight, waist circumference,blood pressure and medical history(a little more than three symptoms,spontaneous ketosis,family history of diabetes). Detect the clinical datas, including fasting plasma glucose(FPG), 2-hour post-meal blood glucose(2h PG), fasting serum c-peptide(FCP), 2-hour post-meal serum c-peptide(2h CP), triglyceride(TG), total cholesterol(TC), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C), hemoglobin A1c(Hb Alc). Each patients be checked with somatosensory evoked potential, funduscopic examination and determine urine protein. Detect GADA concentration and then choose the group of LADA and the group of T2 DM.Analyse the clinical ane experimental data statistically.Results:1. In this research, 7.6%(47 cases) among newly dignosed patients(616 cases) meet the criteria of LADA with GADA positivity.Among LADA cases,there are 26 cases(55.32%) of men and 21 cases(44.68%) of women with no significant difference(P=0.067).2.The incidence of a little more than three symptoms(χ2=7.489, P=7.489) and spontaneous ketosis(χ2=15.953, P<0.001) in group LADA are higer than in group T2 DM. The ratio of family history of diabetes(χ2=13.856, P<0.001) is lower than group T2 DM. Group LADA has lesser BMI(t=10.266, P<0.001) and waist circumference(t=7.492, P<0.001).3.Group LADA has lower TG level(t=4.525, P<0.001), and higher HDL-C level(t=2.956, P=2.956) than group T2 DM. The level of TC(t=2.834, P=0.06), LDL-C(t=1.356, P=1.356), systolic blood pressure(t=0.290, P=0.290) and diastolic blood pressure levels(t=1.976, P=1.976) of differences in two groups are not significant.4.Group LADA has higher levels of FPG(t=5.910, P<0.001), 2h PG(t=5.615, P<5.615) and Hb A1C(t=11.352, P<0.001) than group T2 DM, while the levels of FCP(t=17.393, P<17.393) and 2h CP(t=17.313, P<0.001) are both lower.5. The morbidity of metabolic syndrome in group LADA is lower than in group T2DM(χ2=14.831, P<0.001).6. The incidence of diabetic peripheral neuropathy(χ2=1.547, P=1.547), diabetic retinopathy(χ2=0.575, P=0.575) and diabetic nephropathy(χ2=0.255, P=0.255) of difference in two groups are not significant.Conclusion:1. The morbidity of LADA among newly diagnosed is 7.6% among newly dignosed T2 DM, and gender difference is not significant.2. LADA has higher incidence of a little more than three symptoms and spontaneous ketosis, and lower ratio of family history of diabetes than in group T2 DM.3. LADA has lesser BMI and waist circumference than T2 DM, which means LADA patients are thinner than T2 DM patients.4. LADA patients show lower TG level and higher HDL-C level than T2 DM.5. The levels of FPG, 2h PG and Hb A1 C among LADA patients are higher than T2 DM, and the levels of FCP and 2h CP are lower in LADA than T2 DM patients; the results show LADA has less islet function than T2 DM.6. The incidence of metabolic syndrome in LADA patients is lower than T2 DM so as the incidence of central obesity and hypertriglyceridemia. It means T2 DM patients may get metabolic syndrome easier.7. The incidence of diabetic peripheral neuropathy, diabetic retinopathy and diabetic nephropathy have no obvious difference in two groups.