Clinical features of childhood diabetes mellitus focusing on latent autoimmune diabetes
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Purpose: This study was designed to evaluate the clinical characteristics of childhood diabetes mellitus (DM) according to its classification as well as the clinical course of latent autoimmune diabetes (LAD) that initially showed noninsulin dependence despite autoantibody positivity. Methods: A total of 91 subjects diagnosed between 2001 and 2015 were enrolled in the study. They were classified into 3 groups: type 1 DM, LAD, and type 2 DM. Clinical features and laboratory findings were compared among groups. Results: Among 91 subjects, type 1 DM, LAD, and type 2 DM were 51 (56.0%), 7 (7.7%), and 33 (36.3%), respectively. In LAD, age at diagnosis and BMI Zscores were higher, as compared with those in type 1 DM. Initial serum cpeptide levels were higher in LAD than those in type 1 DM, but lower than those in type 2 DM. In LAD, the mean followup duration was 4.56 years, and 43% of the patients ultimately required intensive insulin treatment with dosage of > 0.5 U/kg/day. HbA1C and serum cpeptide levels at the time of intensive insulin treatment were 9.43±0.93% and 1.37±1.36 ng/mL, respectively. Recent serum cpeptide/glucose ratio was lower in the group requiring intensive insulin treatment than the group without intensive insulin treatment, with Pvalue of 0.057 (0.003±0.005 vs. 0.071±0.086). Conclusion: Initial autoantibody evaluation is useful for classification and management. Close monitoring of the patients with LAD is important due to the expected need for intensive insulin treatment within several years.
Abstract
Purpose: This study was designed to evaluate the clinical characteristics of childhood diabetes mellitus (DM) according to its classification as well as the clinical course of latent autoimmune diabetes (LAD) that initially showed noninsulin dependence despite autoantibody positivity. Methods: A total of 91 subjects diagnosed between 2001 and 2015 were enrolled in the study. They were classified into 3 groups: type 1 DM, LAD, and type 2 DM. Clinical features and laboratory findings were compared among groups. Results: Among 91 subjects, type 1 DM, LAD, and type 2 DM were 51 (56.0%), 7 (7.7%), and 33 (36.3%), respectively. In LAD, age at diagnosis and BMI Zscores were higher, as compared with those in type 1 DM. Initial serum cpeptide levels were higher in LAD than those in type 1 DM, but lower than those in type 2 DM. In LAD, the mean followup duration was 4.56 years, and 43% of the patients ultimately required intensive insulin treatment with dosage of > 0.5 U/kg/day. HbA1C and serum cpeptide levels at the time of intensive insulin treatment were 9.43±0.93% and 1.37±1.36 ng/mL, respectively. Recent serum cpeptide/glucose ratio was lower in the group requiring intensive insulin treatment than the group without intensive insulin treatment, with Pvalue of 0.057 (0.003±0.005 vs. 0.071±0.086). Conclusion: Initial autoantibody evaluation is useful for classification and management. Close monitoring of the patients with LAD is important due to the expected need for intensive insulin treatment within several years.
참고문헌 (31)
- Boehme MW, "Prevalence, incidence and concomitant co-morbidities of type 2 diabetes mellitus in South Western Germany: a retrospective cohort and case control study in claims data of a large statutory health insurance", BMC Public Health, 15, pp.855~ (2015)
- D'Adamo E, "Type 2 diabetes in youth: epidemiology and pathophysiology", Diabetes Care, 34(Suppl 2), pp.S161~S165 (2011)
- Dabelea D, "Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009", JAMA, 311, pp.1778~1786 (2014)
- Reinehr T, "Type 2 diabetes mellitus in children and adolescents", World J Diabetes, 4, pp.270~281 (2013)
- Chen L, "The worldwide epidemiology of type 2 diabetes mellitus--present and future perspectives", Nat Rev Endocrinol, 8, pp.228~236 (2011)
- Nambam B, "Latent autoimmune diabetes in adults: A distinct but heterogeneous clinical entity", World J Diabetes, 1, pp.111~115 (2010)
- Jones AG, "The clinical utility of C-peptide measurement in the care of patients with diabetes", Diabet Med, 30, pp.803~817 (2013)
- Hosszúfalusi N, "Similar genetic features and different islet cell autoantibody pattern of latent autoimmune diabetes in adults (LADA) compared with adult-onset type 1 diabetes with rapid progression", Diabetes Care, 26, pp.452~457 (2003)
- 문진수, "2007 한국 소아 청소년 성장도표 : 개발 과정과 전망", Korean Journal of Pediatrics, 51(1), pp.1~25 (2008), 대한소아과학회
- Kliegman RM, "Nelson textbook of pediatrics" (2016), Elsevier
- Hu FB, "Globalization of diabetes: the role of diet, lifestyle, and genes", Diabetes Care, 34, pp.1249~1257 (2011)
- Rao PV, "Type 2 diabetes in children: clinical aspects and risk factors", Indian J Endocrinol Metab, 19(Suppl 1), pp.S47~S50 (2015)
- Rosenbloom AL, "Type 2 diabetes in children and adolescents", Pediatr Diabetes, 10(Suppl 12), pp.17~32 (2009)
- Naik RG, "Latent autoimmune diabetes in adults (LADA)", Rev Endocr Metab Disord, 4, pp.233~241 (2003)
- Palmer JP, "Is latent autoimmune diabetes in adults distinct from type 1 diabetes or just type 1 diabetes at an older age?", Diabetes, 54(Suppl 2), pp.S62~S67 (2005)
- Pipi E, "Distinct clinical and laboratory characteristics of latent autoimmune diabetes in adults in relation to type 1 and type 2 diabetes mellitus", World J Diabetes, 5, pp.505~510 (2014)
- Kobayashi T, "Immunogenetic and clinical characterization of slowly progressive IDDM", Diabetes Care, 16, pp.780~788 (1993)
- Maddaloni E, "Latent autoimmune diabetes in adults in the United Arab Emirates: clinical features and factors related to insulin-requirement", PLoS One, 10, pp.e0131837~ (2015)
- Klingensmith GJ, "The presence of GAD and IA-2 antibodies in youth with a type 2 diabetes phenotype:results from the TODAY study", Diabetes Care, 33, pp.1970~1975 (2010)
- 조민정, "Fasting serum C-peptide is useful for initial classification of diabetes mellitus in children and adolescents", Annals of Pediatirc Endocrinology & Metabolism, 19(2), pp.80~85 (2014), 대한소아내분비학회
- Lohmann T, "Titre and combination of ICA and autoantibodies to glutamic acid decarboxylase discriminate two clinically distinct types of latent autoimmune diabetes in adults (LADA)", Diabetologia, 44, pp.1005~1010 (2001)
- Ludvigsson J, "C-peptide in the classification of diabetes in children and adolescents", Pediatr Diabetes, 13, pp.45~50 (2012)
- Saisho Y, "Postprandial serum C-peptide to plasma glucose ratio as a predictor of subsequent insulin treatment in patients with type 2 diabetes", Endocr J, 58, pp.315~322 (2011)
- Sonoda R, "C-peptide level in fasting plasma and pooled urine predicts HbA1c after hospitalization in patients with type 2diabetes mellitus", PLoS One, 11, pp.e0147303~ (2016)
- Hope SV, "Practical Classification Guidelines for Diabetes in patients treated with insulin: a cross-sectional study of the accuracy of diabetes diagnosis", Br J Gen Pract, 66, pp.e315~e322 (2016)
- Fowler MJ, "Microvascular and macrovascular complications of diabetes", Clin Diabetes, 26, pp.77~82 (2008)
- Boyle PJ, "Diabetes mellitus and macrovascular disease:mechanisms and mediators", Am J Med, 120(9 Suppl 2), pp.S12~S17 (2007)
- Emerging Risk Factors Collaboration, "Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies", Lancet, 375, pp.2215~2222 (2010)
- Emerging Risk Factors Collaboration, "Diabetes mellitus, fasting glucose, and risk of cause-specific death", N Engl J Med, 364, pp.829~841 (2011)
- Butwicka A, "Risks of psychiatric disorders and suicide attempts in children and adolescents with type 1 diabetes: a populationbased cohort study", Diabetes Care, 38, pp.453~459 (2015)
- Ducat L, "A review of the mental health issues of diabetes conference", Diabetes Care, 38, pp.333~338 (2015)