Аутоиммунный сахарный диабет взрослых

Статья в Elpub

Рецепт. 2018; : 392-400

Аутоиммунный сахарный диабет взрослых

Басик А. Р., Дудик Н. М., Данилова Л. И.

Аннотация

Диагностика различных типов сахарного диабета (СД) основывается на клинических характеристиках и в типичных случаях не вызывает трудностей. В последние годы клиницисты обращают внимание на возрастание случаев СД, которые не отвечают традиционным критериям действующей классификации ВОЗ (1999). Помимо латентного аутоиммунного диабета взрослых (LADA) стали выделять варианты с более агрессивной потерей функционирующего пула b-клеток поджелудочной железы и быстрым развитием потребности в заместительной инсулинотерапии. Вариант диабета по типу латентного аутоиммунного диабета взрослых встречается в 2-12% всех случаев диабета, характеризуется клинической картиной, не типичной для классического СД 1-го типа (СД1). Несмотря на наличие аутоантител к компонентам b-клеток, их аутоиммунная деструкция развивается медленно, что не сразу приводит к развитию эндогенной инсулиновой недостаточности. Вариант диабета по типу LADA занимает промежуточное положение между СД1 и СД 2-го типа (СД2), в классификации 1999 г. не выделен в отдельную номенклатурную единицу. Наличие в дебюте заболевания клинической картины, характерной для СД2, затрудняет раннюю диагностику и своевременный старт инсулинотерапии у пациентов с разными вариантами аутоиммунного диабета.

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Recipe. 2018; : 392-400

Autoimmune diabetes mellitus in adults

Basik A. ., Dudyk N. ., Danilova L. .

Abstract

Diagnostics of different types of diabetes mellitus (DM) is based on clinical characteristics and causes no difficulties in typical cases. In recent years, clinicians pay attention to the forms of diabetes mellitus that do not meet the traditional criteria of the classification of the WHO (1999). Besides latent autoimmune diabetes in adults (LADA) new variants of autoimmune diabetes are verified in adults with more aggressive loss of functioning the pool b-cells pancreas and rapid development needs in substitution insulin therapy. LADA is one of variants of autoimmune diabetes mellitus, occurs in 2-12% of all cases of DM, it is characterized by the clinical picture which is not typical for classic DM type 1, despite the availability of autoantibodies. The autoimmune destruction develops slowly, and it does not lead to insulin demand immediately. This form of DM occupies the intermediate position between DM type 1 and type 2, does not form a separate nomenclatural unit in the latest classification. Presence of 2 type DM clinical features by the moment of the diseasedebut makes difficulties for differential diagnosis and postpone the well-timed start of the insulin therapy in patients with different variants of autoimmune diabetes in adults.

References