Abstract：
OBJECTIVE: Patients with GAD antibodies (GADAb) showing clinical features of type 2 diabetes typically exhibit progression to an insulin-dependent state in several months or years. This condition is diagnosed as slowly progressive insulin-dependent (type 1) diabetes mellitus (SPIDDM) or latent autoimmune diabetes in adults, a subtype of adult-onset autoimmune diabetes. However, some patients diagnosed with adult-onset autoimmune diabetes do not progress to an insulin-dependent state. We conducted a retrospective cohort study to identify patients with non-insulin-dependent diabetes among those diagnosed with adult-onset autoimmune diabetes using measurable indicators in routine clinical practice.
METHODS: We surveyed data from the electronic medical records of all patients with GADAb from eight medical centres in Japan for selecting and analysing patients who matched the diagnostic criteria of SPIDDM.
RESULTS: Overall, 345 patients were analysed; of these, 162 initiated insulin therapy (insulin therapy group), whereas 183 did not (non-insulin therapy group) during the follow-up period (median 3.0 years). Patients in the non-insulin therapy group were more likely to be male and presented a later diabetes onset, shorter duration of diabetes, higher BMI, higher blood pressure levels, lower HbA1c levels, lower GADAb levels and lesser antidiabetic agent use than those in the insulin therapy group when GADAb was first identified as positive. A Cox proportional hazards model showed that BMI, HbA1c levels and GADAb levels were independent factors for progression to insulin therapy. Kaplan-Meier analyses revealed that 86.0% of the patients with diabetes having GADAb who presented all three factors (BMI ≥ 22 kg/m2, HbA1c < 75 mmol/mol [9.0%] and GADAb <10.0 U/ml) did not require insulin therapy for 4 years.
CONCLUSIONS: Higher BMI (≥22 kg/m2), lower HbA1c (<75 mmol/mol [9.0%]) and lower GADAb levels (<10.0 U/ml) can predict a non-insulin-dependent state for at least several years in Japanese patients with diabetes having GADAb.
METHODS: We surveyed data from the electronic medical records of all patients with GADAb from eight medical centres in Japan for selecting and analysing patients who matched the diagnostic criteria of SPIDDM.
RESULTS: Overall, 345 patients were analysed; of these, 162 initiated insulin therapy (insulin therapy group), whereas 183 did not (non-insulin therapy group) during the follow-up period (median 3.0 years). Patients in the non-insulin therapy group were more likely to be male and presented a later diabetes onset, shorter duration of diabetes, higher BMI, higher blood pressure levels, lower HbA1c levels, lower GADAb levels and lesser antidiabetic agent use than those in the insulin therapy group when GADAb was first identified as positive. A Cox proportional hazards model showed that BMI, HbA1c levels and GADAb levels were independent factors for progression to insulin therapy. Kaplan-Meier analyses revealed that 86.0% of the patients with diabetes having GADAb who presented all three factors (BMI ≥ 22 kg/m2, HbA1c < 75 mmol/mol [9.0%] and GADAb <10.0 U/ml) did not require insulin therapy for 4 years.
CONCLUSIONS: Higher BMI (≥22 kg/m2), lower HbA1c (<75 mmol/mol [9.0%]) and lower GADAb levels (<10.0 U/ml) can predict a non-insulin-dependent state for at least several years in Japanese patients with diabetes having GADAb.
摘要：
目的：具有2型糖尿病临床特征的GAD抗体（GADAb）患者通常在几个月或几年内表现出进展为胰岛素依赖性状态。这种情况被诊断为成人缓慢进行性胰岛素依赖型（1型）糖尿病（SPIDDM）或隐匿性自身免疫性糖尿病，成人发病的自身免疫性糖尿病的一种亚型。然而,一些被诊断为成年型自身免疫性糖尿病的患者不会进展到胰岛素依赖状态.我们进行了一项回顾性队列研究，以使用常规临床实践中的可测量指标，在诊断为成人发作的自身免疫性糖尿病的患者中确定非胰岛素依赖型糖尿病患者。
方法：我们调查了来自日本8个医疗中心的所有GADAb患者的电子病历数据，以选择和分析符合SPIDDM诊断标准的患者。
结果：总体而言，对345名患者进行了分析；其中，162开始胰岛素治疗（胰岛素治疗组），而183例(非胰岛素治疗组)在随访期间(中位3.0年)没有.非胰岛素治疗组的患者更可能是男性，并且糖尿病发病较晚。糖尿病持续时间较短，BMI较高,更高的血压水平，较低的HbA1c水平，当GADAb首次被鉴定为阳性时,与胰岛素治疗组相比,GADAb水平较低,抗糖尿病药物使用量较少.Cox比例风险模型表明，BMI，HbA1c水平和GADAb水平是胰岛素治疗进展的独立因素。Kaplan-Meier分析显示，86.0％的GADAb糖尿病患者存在所有三个因素（BMI≥22kg/m2，HbA1c<75mmol/mol[9.0％]和GADAb<10.0U/ml）不需要胰岛素治疗4年。
结论：较高的BMI（≥22kg/m2），较低的HbA1c(<75mmol/mol[9.0%])和较低的GADAb水平(<10.0U/ml)可以预测日本患有GADAb的糖尿病患者至少数年的非胰岛素依赖性状态.
方法：我们调查了来自日本8个医疗中心的所有GADAb患者的电子病历数据，以选择和分析符合SPIDDM诊断标准的患者。
结果：总体而言，对345名患者进行了分析；其中，162开始胰岛素治疗（胰岛素治疗组），而183例(非胰岛素治疗组)在随访期间(中位3.0年)没有.非胰岛素治疗组的患者更可能是男性，并且糖尿病发病较晚。糖尿病持续时间较短，BMI较高,更高的血压水平，较低的HbA1c水平，当GADAb首次被鉴定为阳性时,与胰岛素治疗组相比,GADAb水平较低,抗糖尿病药物使用量较少.Cox比例风险模型表明，BMI，HbA1c水平和GADAb水平是胰岛素治疗进展的独立因素。Kaplan-Meier分析显示，86.0％的GADAb糖尿病患者存在所有三个因素（BMI≥22kg/m2，HbA1c<75mmol/mol[9.0％]和GADAb<10.0U/ml）不需要胰岛素治疗4年。
结论：较高的BMI（≥22kg/m2），较低的HbA1c(<75mmol/mol[9.0%])和较低的GADAb水平(<10.0U/ml)可以预测日本患有GADAb的糖尿病患者至少数年的非胰岛素依赖性状态.
