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Diabetes autoinmune latente del adulto o diabetes tipo 1 de lenta progresión: definición, patogenia, clínica, diagnóstico y tratamiento Latent autoimmune diabetes of the adult or type 1 diabetes of slow progression: definition, pathogeny, clinic, diagnosis and treatment  [cached]
Eduardo Cabrera Rode,Pedro A. Perich Amador,Manuel E. Licea Puig
Revista Cubana de Endocrinología , 2002,
Abstract: Se sabe que la diabetes mellitus es un síndrome heterogéneo que tiene como elemento común una hiperglucemia crónica, como consecuencia de una deficiencia de insulina o una insuficiente efectividad de su acción. Nos propusimos en este trabajo describir los aspectos más relevantes de la diabetes autoinmune del adulto (LADA) y exponer el resultado de nuestra experiencia. Se considera que un sujeto la padece cuando es clasificado inicialmente como diabético tipo 2, el inicio es después de los 34 a os, tiene generalmente peso corporal, normal o bajo y en un tiempo relativamente corto necesita tratamiento insulínico para lograr un buen control metabólico y presenta además una mayor asociación con la producción de anticuerpos antiislotes (ICA), antiglutámico descarboxilasa (AGAD65), microsomales tiroideos y antigástricos parietales, con una susceptibilidad genética por la presencia de haplotipos HLA-DR. Al momento del diagnóstico clínico puede presentar o no una insulinodeficiencia. Se ha demostrado que la insulinoterapia es el tratamiento ideal para los individuos con LADA, con el mismo se ha evidenciado una alta tasa de conversión negativa de los ICA con un incremento de los niveles de péptido C en el suero. Por el contrario, el tratamiento con sulfonilureas produce una persistencia de los ICA, los que probablemente sean responsables de una destrucción progresiva de las células b del páncreas. Por tanto, estas observaciones justifican la elección de la insulinoterapia desde el mismo momento del diagnóstico. It is known that diabetes mellitus is an heterogeneous syndrome that has as a common element a chronic hyperglycaemia resulting from an insulin deficiency or from an insufficient effectiveness of its action. It is our purpose to describe the most significant aspects of the autoimmune diabetes of the adult and to show the result of our experience. It is considered that subjects suffer from it when they are initially classified as type 2 diabetics, with an onset of the disease after the age of 34. They generally have normal or low body weight and in a relatively short time need insulin treatment to attain a good metabolic control. They also present a greater association with the production of islet cell antibodies (ICA), antiglutamic acid decarboxylase (AGAD65), thyroid microsomial antibodies and parietal antigastric antibodies, with a genetic susceptibility due to the presence of HLA-DR haplotypes. They may have or not insulin deficiency at the time of the clinical diagnosis. It has been proved that insulin therapy is the ideal treatment for individuals wi
Genotipificación del gen HLA DQB1 en diabetes autoinmune del adulto (lada) HLA DQB1 genotyping in latent autoimmune diabetes of adults (LADA)  [cached]
Mariela Caputo,Gloria E. Cerrone,Ariel P. López,Claudio Gónzalez
Medicina (Buenos Aires) , 2005,
Abstract: La diabetes autoinmune es una enfermedad multifactorial causada por factores genéticos predisponentes y ambientales desencadenantes. Se manifiesta en la edad infantojuvenil (diabetes tipo 1, DMID) y en la edad adulta (diabetes autoinmune latente del adulto, LADA). La predisposición genética es de tipo poligénico, se ha establecido asociación con alelos polimórficos del gen DQB del sistema HLA, VNTR del gen de insulina y polimorfismos en el gen CTLA4. En el presente trabajo se analizaron las frecuencias de los alelos polimórficos del gen HLA DQB1 en 63 pacientes LADA, 70 pacientes DMID y 79 individuos normales. La tipificación de los alelos del gen DQB1 se llevó a cabo mediante el Kit SSP TM DQ Olerup. Se observó una mayor frecuencia del genotipo *0201-*0302 y *0201-*0201 en ambas poblaciones diabéticas con respecto a normales (p<0.05). La presencia del genotipo *0201-*0302 fue mayor en DMID que en LADA (p<0.05). Por otra parte, el análisis del alelo protector *0602 muestra una alta prevalencia en individuos normales con respecto a la población diabética. El alelo de susceptibilidad más frecuente en pacientes LADA y DMID de nuestro país fue el *0201. En conclusión, LADA presenta susceptibilidad genética dada por alelos del gen HLA DQB1 pero en forma menos determinante que en diabetes tipo 1. A su vez, el hallazgo del aumento en la frecuencia del alelo *0201, tanto en frecuencias alélicas como genotípicas permite caracterizar nuestra población de pacientes tanto LADA como DMID a diferencia de otras poblaciones en las que el alelo más frecuente es el *0302. Autoimmune diabetes is a complex, multifactorial disease caused by the interaction of genetic and environmental factors. This autoimmune diabetes is commonly manifested in childhood and adolescence with a fast onset (type 1 diabetes, IDDM) and it can occur in adult patients with a slow onset with delayed insulin requirement, (latent autoimmune diabetes in adults, LADA ). Autoimmune diabetes has strong class II HLA association mainly with DQB gene which constitutes the first susceptibility locus. However, association with the 5’INS- VNTR and CTLA-4 genes has been established. In this study, we analysed the polimorphic allele frequencies of DQB HLA gene in 63 LADA patients, 70 IDDM and 79 control subjects. The HLA DQB1 alleles typing was detected through Olerup SSP TM DQ kit using sequence specific primers. We observed a positive association of *0201-*0302 and *0201-*0201 genotypes in both types of diabetic patients compared to the control group (p<0.05). Moreover, *0201-*0302 genotype was higher in IDDM
Diabetes autoinmune latente del adulto o diabetes tipo 1 de lenta progresión: definición, patogenia, clínica, diagnóstico y tratamiento
Cabrera Rode,Eduardo; Perich Amador,Pedro A.; Licea Puig,Manuel E.;
Revista Cubana de Endocrinolog?-a , 2002,
Abstract: it is known that diabetes mellitus is an heterogeneous syndrome that has as a common element a chronic hyperglycaemia resulting from an insulin deficiency or from an insufficient effectiveness of its action. it is our purpose to describe the most significant aspects of the autoimmune diabetes of the adult and to show the result of our experience. it is considered that subjects suffer from it when they are initially classified as type 2 diabetics, with an onset of the disease after the age of 34. they generally have normal or low body weight and in a relatively short time need insulin treatment to attain a good metabolic control. they also present a greater association with the production of islet cell antibodies (ica), antiglutamic acid decarboxylase (agad65), thyroid microsomial antibodies and parietal antigastric antibodies, with a genetic susceptibility due to the presence of hla-dr haplotypes. they may have or not insulin deficiency at the time of the clinical diagnosis. it has been proved that insulin therapy is the ideal treatment for individuals with lada. a high rate of negative conversion of the ica with an increase of the levels of c-peptide in serum has been evidenced. on the contrary, the sulphonylurea treatment produces a persistence of the ica, which are probably responsible for the destruction of the b-cells of the pancreas. therefore, these observations justify the election of insulin therapy at the very moment of the diagnosis.
Nueva definición, prevalencia, caracterización y tratamiento de la diabetes autoinmune latente del adulto A new definition, prevalence, characterization, and treatment of the latent autoimmune diabetes of adult  [cached]
Eduardo Cabrera Rode,Manuel E Licea Puig
Revista Cubana de Endocrinología , 2008,
Abstract: La diabetes autoinmune latente del adulto es una forma de diabetes autoinmune que está presente en algunos sujetos equívocamente clasificados como diabéticos tipo 2. La progresión del da o autoinmune de las células en esta entidad es más lenta que en los ni os con diabetes tipo 1. Las personas que la padecen, al momento del diagnóstico, presentan una mayor preservación de la función de las células que aquellos con la diabetes tipo 1 clásica. Su diagnóstico actual está basado en 3 características: edad igual o superior a 30 a os (aunque se pueda encontrar también en sujetos con edades inferiores a 30 a os); la presencia de al menos 1 de los 5 autoanticuerpos contra los antígenos pancreáticos de las células de los islotes (autoanticuerpos antiislotes [ICA], antidescarboxilasa del ácido glutámico [AGAD], anticuerpos contra la tirosina fosfatasa [AIA2] y contra el transportador del catión zinc dentro las células de los islotes [AZnT8]), y la necesidad de requerimientos de insulina, al menos 6 meses después del diagnóstico. Está presente en el 10 % de los individuos con diabetes tipo 2 con edades 335 a os y en el 25 % de los menores de 35. Se han descrito varios genes de susceptibilidad para ella, que incluyen los genes HLA DR3/DR4 y DQB1*0201/DQB1*0302, DQB1*0602, MHC clase I relacionados con la cadena A (MICA), así como del alelo VNTR clase I, entre otros, los que la asemejan o diferencian tanto de la diabetes tipo 1 clásica como de la tipo 2. Estudios prospectivos sobre la función de las células muestran que los sujetos que tienen múltiples autoanticuerpos asociados a diabetes tipo 1, desarrollan un fallo de la función de las células dentro de los primeros 5 a os de duración de la diabetes, mientras que la mayoría de aquellos con solo AGAD ó ICA desarrollan el fallo de la función de estas células después de los 5 a os. En estas personas puede ocurrir un fallo de la función de las células hasta a los 12 a os después del diagnóstico de la enfermedad, aunque el deterioro de la respuesta de las células a la glucosa intravenosa o al glucagón puede ser detectado en algunos sujetos al diagnóstico de la diabetes. Por tal razón, no estamos en presencia de una enfermedad latente. Existen varios estudios que sugieren que el tratamiento con insulina es el más indicado al momento del diagnóstico de la enfermedad para contrarrestar el da o de la función de las células . En este trabajo, se revisó lo relacionado con su definición, la genética, la presencia de autoanticuerpos antiislotes y su patogenia, así como las experiencias con la función de las células
Diabetes autoinmune (latente) del adulto Latent autoimmune diabetes in adults
Felipe Pollak C,Tatiana Vásquez A
Revista médica de Chile , 2012,
Abstract: Backgroud: Latent Autoimmune Diabetes in Adults (LADA) is the term used to describe adults who have a slowly progressive form of diabetes mellitus (DM) of autoimmune etiology, but that may be treated initially without insulin. Although it shares some immunological and genetic aspects with type 1 DM, it affects an age group that is typically affected by type 2 DM. Therefore, it could be considered an intermediate type. Diagnosis is based on clinical and laboratory criteria: age of onset, initial response to oral hypoglycemic agents and the presence of specific antibodies for diabetes. Although the definitive treatment is insulin, glitazones may be useful in early stages of the disease. Currently, its management represents a challenge for the physician, including specialists, and it is a form of DM to keep in mind.
Nueva definición, prevalencia, caracterización y tratamiento de la diabetes autoinmune latente del adulto
Cabrera Rode,Eduardo; Licea Puig,Manuel E;
Revista Cubana de Endocrinolog?-a , 2008,
Abstract: latent autoimmune diabetes of adult is a way of autoimmune diabetes present in some subjects erroneously classified as type 2 diabetics. progression of autoimmune damage of ? cells in this entity is slower than in children presenting with type 1 diabetes. at diagnosis, persons affected by this condition, have a greater preservation of ? cells function than those presenting with the classic type 1 diabetes. their present diagnosis is based on 3 features: age similar o greater than 30 years (however, it may be present in subjects in ages lower than 30 years); presence of at least 1 of the 5 antibodies to pancreatic antigens of islet-cells (anti-islet [ai] auto-antibodies, anti-descarboxylase of glutamic acid [agad], antibodies to phosphatase tyrosine [aia2], and to zinc-cation transporter within ? islet-cells [aznt8]), and the need of insulin requirements, at least 6 months after diagnosis. it is present in 10 % of subjects presenting with type 2 diabetes in 335 years, and in 25 % of those younger than 35 years. some genes of susceptibility for it are described, including genes hla dr3/dr4 and dqb1*0201/dqb1*0302, dqb1*0602, class i mhc related to a chain (mica), as well as class i vntr allele, among others, those similar o different of the classic type 1 diabetes or the type 2. prospective studies on function of ? cells show that subject carriers of it with multiple auto-antibodies associated to type 1 diabetes develops a failure of function above mentioned within the first 5 years of duration of diabetes, while the most of those with on agad or ica develop a failure in this function after 5 years. in these persons may to occur a failure in function of ? cells up to 12 years after diagnosis of disease, although deterioration of ? cells response to i.v. glucose or glucagon, may be detected in some subjects at diagnosis of diabetes. thus, we aren't in presence of a latent disease. there are studies suggesting that insulin-treatment is the more appropriate at diagnosis
Genotipificación del gen HLA DQB1 en diabetes autoinmune del adulto (lada)
Caputo,Mariela; Cerrone,Gloria E.; López,Ariel P.; Gónzalez,Claudio; Mazza,Carmen; Cedola,Norberto; Puchulu,Félix M.; Targovnik,Héctor M.; Frechtel,Gustavo D.;
Medicina (Buenos Aires) , 2005,
Abstract: autoimmune diabetes is a complex, multifactorial disease caused by the interaction of genetic and environmental factors. this autoimmune diabetes is commonly manifested in childhood and adolescence with a fast onset (type 1 diabetes, iddm) and it can occur in adult patients with a slow onset with delayed insulin requirement, (latent autoimmune diabetes in adults, lada ). autoimmune diabetes has strong class ii hla association mainly with dqb gene which constitutes the first susceptibility locus. however, association with the 5?ins- vntr and ctla-4 genes has been established. in this study, we analysed the polimorphic allele frequencies of dqb hla gene in 63 lada patients, 70 iddm and 79 control subjects. the hla dqb1 alleles typing was detected through olerup ssptm dq kit using sequence specific primers. we observed a positive association of *0201-*0302 and *0201-*0201 genotypes in both types of diabetic patients compared to the control group (p<0.05). moreover, *0201-*0302 genotype was higher in iddm than in lada (p<0.05). on the other hand, the *0602 protective allele analysis showed a high prevalence in the normal group compared to the diabetic population. in argentina, the most frequent allele of susceptibility in lada and iddm patients was the *0201. summing up, the finding of an increase in the *0201 allele, both in allelic and genotypic frequencies, allows the characterisation of our population of patients, lada and iddm, unlike other populations, in which the most frequent allele is *0302.
Diabetes auto-imune latente do adulto ou diabetes melito tipo 2 magro?
Calsolari, Maria Regina;Rosário, Pedro W. Souza do;Reis, Janice Sepúlveda;Silva, Saulo Cavalcanti da;Purisch, Saulo;
Arquivos Brasileiros de Endocrinologia & Metabologia , 2008, DOI: 10.1590/S0004-27302008000200019
Abstract: the prevalence of latent autoimmune diabetes of the adult (lada) varies according to the population studied, criteria used and antibodies analyzed. in a series of 256 patients > 25 years, we found that 26 (10.2%) were anti-gad antibody (gada) positive and 16 of them (6.3%) progressed without initial insulin requirement. although controversy exists, the following diagnostic criteria for lada are suggested: age between 25 and 65 years; absence of ketoacidosis or symptomatic hyperglycemia at diagnosis or immediately thereafter, without insulin requirement for 6-12 months; and presence of autoantibodies (especially gada). autoimmunity and insulin resistance coexist in lada and the contribution of these factors seems to be reflected in gada titers. a subgroup, which is phenotypically and in terms of insulin requirement similar to type 2 diabetic patients, seems to be better identified based on the presence of low gada titers, especially when these antibodies are present alone. on the other hand, subjects with high gada titers and multiple antibodies show a phenotype close to that of classical dm 1 and are at a higher risk of premature beta-cell failure. compared to gada-negative diabetics, patients with lada present a higher prevalence of other autoantibodies (anti-tpo, anti-21-hydroxylase and antibodies associated with celiac disease) and a higher frequency of genotypes and haplotypes indicating a risk for dm 1. patients with high gada titers may benefit from early insulinization and avoiding the use of sulfonylureas, delaying beta-cell failure. in contrast, patients with low gada titers do not seem to have any disadvantage when managed as type 2 diabetic patients (gada negative).
Frecuencia de maculopatía en pacientes con diabetes mellitus tipo 2: Reporte preliminar
Fernández Leyva,Harberth; Licea Puig,Manuel E.; Morales Martínez,Miguel;
Revista Cubana de Endocrinolog?-a , 2002,
Abstract: a cross-sectional study was conducted among 542 patients with ica-type 2 diabetes mellitus consecutively recruited at the diabetic care center. a complete medical history and an ophthalmological examination: biomicroscopy and ophthalmoscopy (direct and indirect) and examination with lens of 90dp were made. fasting glycaemia, 2 hours after breakfast and lunch, glycosilated haemoglobin (hba1) and urinary albumin excretion (uae) were determined. maculopathy was classified as exudative, edematous and ischaemic and it was related to sex, smoking habit, treatments of dm, present age, age at the onset of the disease, arterial pressure and biochemical variables, such as fasting glycaemia, postprandial glycaemia, hba1 and uae. the clinical nephropathy (uae 3 300 mg/l) was excluded. type 2 diabetes mellitus was considered as of recent presentation when the clinical diagnosis was lower than 6 months. 95 patients (17.5 %) suffered some type of maculopathy; 49 (9.0 %), exudative forms; 29 (5.3 %), edematous forms; and 17 (3.2), ischaemic forms. no significant differences were observed as regards sex, smoking habit or treatments used, on dividing them according to the presence or not of maculopathy. the duration of dm was of 12.4 ± 9.45 years for patients with maculopathy, with statistically significant difference (p<0.01). on correlating maculopathy with arterial hypertension, marked differences were obtained (p<0.04) in the edematous forms. of the total of patients with dm of recent presentation, 14 (2.6 %) suffered from some type of this affection. it was concluded that diabetic maculopathy is frequent and that it is not an exception to observe it at the moment of the clinical presentation of dm. the edematous form is significantly associated with aht. these results oblige to make a complete ophthalmological examination from the moment of the clinical diagnosis.
Treino em auto-observa??o e ades?o à dieta em adulto com diabetes tipo 2
Ferreira, Eleonora Arnaud Pereira;Fernandes, Andressa Lacerda;
Psicologia: Teoria e Pesquisa , 2009, DOI: 10.1590/S0102-37722009000400019
Abstract: the present study verified the effects of self-observation over the adherence to a prescribed diet for an adult with type 2-diabetes. the data collection was brought up by means of home interviews. following the baseline determination, the following steps were performed: a training on the use of protocols for self-monitoring registration (step 1), a training on the patient's verbal report over his feeding on the former day (step 2), and a training on how to plan the adherence to the diet (step 3). the calculation of the patient's adherence index to the diet (aid) along with his verbal reports guided the data analysis, which revealed an increase in the frequency of self-observation of feeding behavior and in the aid on step 1. this gain was maintained on step 2 and further maximized by the training on planning the adherence to the diet on step 3.
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