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Abstract：
OBJECTIVE: Obese youth clinically diagnosed with type 2 diabetes mellitus (T2DM) frequently have evidence of islet cell autoimmunity. We investigated the clinical and biochemical differences, and therapeutic modalities among autoantibody positive (Ab+) vs. autoantibody negative (Ab-) youth at the time of diagnosis and over time in a multi-provider clinical setting.
METHODS: Chart review of 145 obese youth diagnosed with T2DM from January 2003 to July 2012. Of these, 70 patients were Ab+ and 75 Ab-. The two groups were compared with respect to clinical presentation, physical characteristics, laboratory data, and therapeutic modalities at diagnosis and during follow up to assess the changes in these parameters associated with disease progression.
RESULTS: At presentation, Ab+ youth with a clinical diagnosis of T2DM were younger, had higher rates of ketosis, higher hemoglobin A1c (HbA1c) and glucose levels, and lower insulin and c-peptide concentrations compared with the Ab- group. The Ab- group had a higher body mass index (BMI) z-score and cardiometabolic risk factors at diagnosis and such difference remained over time. Univariate analysis revealed that treatment modality had no effect on BMI in either group. Generalized estimating equations for longitudinal data analysis revealed that (i) BMI z-score and diastolic blood pressure (DBP) were significantly affected by duration of diabetes; (ii) systolic blood pressure (SBP) and ALT were affected by changes in BMI z-score; and (iii) changes in HbA1c had an effect on lipid profile and cardiometabolic risk factors regardless of antibody status.
CONCLUSIONS: Irrespective of antibody status and treatment modality, youth who present with obesity and diabetes, show no improvement in obesity status over time, with the deterioration in BMI z-score affecting blood pressure (BP) and ALT, but the lipid profile being mostly impacted by HbA1c and glycemic control. Effective control of BMI and glycemia are needed to lessen the future macrovascular complications irrespective of antibody status.
METHODS: Chart review of 145 obese youth diagnosed with T2DM from January 2003 to July 2012. Of these, 70 patients were Ab+ and 75 Ab-. The two groups were compared with respect to clinical presentation, physical characteristics, laboratory data, and therapeutic modalities at diagnosis and during follow up to assess the changes in these parameters associated with disease progression.
RESULTS: At presentation, Ab+ youth with a clinical diagnosis of T2DM were younger, had higher rates of ketosis, higher hemoglobin A1c (HbA1c) and glucose levels, and lower insulin and c-peptide concentrations compared with the Ab- group. The Ab- group had a higher body mass index (BMI) z-score and cardiometabolic risk factors at diagnosis and such difference remained over time. Univariate analysis revealed that treatment modality had no effect on BMI in either group. Generalized estimating equations for longitudinal data analysis revealed that (i) BMI z-score and diastolic blood pressure (DBP) were significantly affected by duration of diabetes; (ii) systolic blood pressure (SBP) and ALT were affected by changes in BMI z-score; and (iii) changes in HbA1c had an effect on lipid profile and cardiometabolic risk factors regardless of antibody status.
CONCLUSIONS: Irrespective of antibody status and treatment modality, youth who present with obesity and diabetes, show no improvement in obesity status over time, with the deterioration in BMI z-score affecting blood pressure (BP) and ALT, but the lipid profile being mostly impacted by HbA1c and glycemic control. Effective control of BMI and glycemia are needed to lessen the future macrovascular complications irrespective of antibody status.
摘要：
目的：临床诊断为2型糖尿病（T2DM）的肥胖青年经常有胰岛细胞自身免疫的证据。我们调查了临床和生化差异，自身抗体阳性（Ab+）与在诊断时和在多提供者临床环境中，随着时间的推移，自身抗体阴性（Ab-）青年。
方法：图表回顾了2003年1月至2012年7月诊断为T2DM的145名肥胖青年。其中,70例患者为Ab+和75Ab-。比较两组的临床表现，物理特性,实验室数据,以及诊断和随访期间的治疗方式，以评估与疾病进展相关的这些参数的变化。
结果：在演讲中，临床诊断为T2DM的Ab+青年更年轻，酮症发病率较高，更高的血红蛋白A1c（HbA1c）和葡萄糖水平，与Ab组相比，胰岛素和c肽浓度较低。在诊断时,Ab组具有较高的体重指数(BMI)z评分和心脏代谢危险因素,并且这种差异随着时间的推移而保持。单因素分析显示，治疗方式对两组的BMI均无影响。纵向数据分析的广义估计方程显示（i）BMIz评分和舒张压（DBP）受糖尿病持续时间的显着影响；（ii）收缩压（SBP）和ALT受BMIz评分变化的影响；（iii）无论抗体状态如何，HbA1c的变化都对血脂和心脏代谢危险因素有影响。
结论：不考虑抗体状态和治疗方式，患有肥胖和糖尿病的年轻人，随着时间的推移，肥胖状况没有改善，随着BMIz评分的恶化影响血压（BP）和ALT，但血脂主要受HbA1c和血糖控制的影响。无论抗体状态如何，都需要有效控制BMI和血糖以减轻未来的大血管并发症。
方法：图表回顾了2003年1月至2012年7月诊断为T2DM的145名肥胖青年。其中,70例患者为Ab+和75Ab-。比较两组的临床表现，物理特性,实验室数据,以及诊断和随访期间的治疗方式，以评估与疾病进展相关的这些参数的变化。
结果：在演讲中，临床诊断为T2DM的Ab+青年更年轻，酮症发病率较高，更高的血红蛋白A1c（HbA1c）和葡萄糖水平，与Ab组相比，胰岛素和c肽浓度较低。在诊断时,Ab组具有较高的体重指数(BMI)z评分和心脏代谢危险因素,并且这种差异随着时间的推移而保持。单因素分析显示，治疗方式对两组的BMI均无影响。纵向数据分析的广义估计方程显示（i）BMIz评分和舒张压（DBP）受糖尿病持续时间的显着影响；（ii）收缩压（SBP）和ALT受BMIz评分变化的影响；（iii）无论抗体状态如何，HbA1c的变化都对血脂和心脏代谢危险因素有影响。
结论：不考虑抗体状态和治疗方式，患有肥胖和糖尿病的年轻人，随着时间的推移，肥胖状况没有改善，随着BMIz评分的恶化影响血压（BP）和ALT，但血脂主要受HbA1c和血糖控制的影响。无论抗体状态如何，都需要有效控制BMI和血糖以减轻未来的大血管并发症。
