Clinical Characteristics Of Latent Autoimmune Diabetes In Adults

Objective:To compare the clinical characteristics of LADA with T1DM and T2DM, and to study the characteristics and influencing factors of islet β-cell function of LADA.Methods:Between 2013-2016, patients with diagnosed Diabetes Mellitus hospitalized in the First Affiliated Hospital of Guangxi Medical University hospital, whose GADA, ICA and IAA was detected,were included.47 cases with diagnosed T1DM,88 cases with diagnosed LADA,106 cases with diagnosed T2DM were selected. Age, course of diseases, BMI, complications, C-peptide and other information were compared among three groups. Dynamic observation of C peptide levels in some patients were also conducted.Results:(1) The three groups had similar gender composition and course of disease. Compared with T1DM, LADA had older age of onset, higher ratio of positive family history of diabetes, lower incidence of ketosis, higher proportion of cardiovascular disease, cerebrovascular disease, peripheral vascular disease and retinopathy(allP<0.05), and similar proportion of hypertension, diabetic nephropathy and peripheral neuropathy(P>0.05). BMI in LADA group is higher than T1DM, lower than T2DM(P<0.05). (2) The ratio of thyroid diseases in LADA or T1DM was higher than that of T2DM(P<0.05). (3) FCP, Pk-CP, Homa-islet(CP-DM), SCP and C-peptide level at various time points (0,1,2,4,6, 10min) of intravenous glucose tolerance test in LADA group were higher than T1DM but lower than T2DM, the difference was significant(P <0.05). (4) To analysis according to course of the disease, FCP and Pk-CP in the LADA group decreased as the course of the disease extended, while the decline of C-peptide level in T2DM group is not obvious. (5) Dynamic observation of C-peptide. After one year of follow-up, FCP and Pk-CP in LADA group decreased (P>0.05), and were lower than T2DM group(P<0.05), while T2DM group had no significant decline(P>0.05). (6) Multiple stepwise regression analysis shows that C-peptide in LADA had negative relation to duration an HbAlc and was positively correlated with BMI or GADA.Conclusion:(1) Early clinical features of LADA are close to T2DM, as abnormal lipid metabolism, hypertension, higher BMI, which can reflect insulin resistance. (2) The islet β-cell function was significantly better in LADA patients than in T1DM patients, but it was still significantly less than the patients with T2DM. (3) The islet β-cell function of LADA will gradually decrease with the duration of the disease, GADA and the course of disease are the main influencing factors.