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The distance of diabetic nephropathy from uremia

2017-05-14 10:42

The experts found that some adult patients with type 2 diabetes is not fat, but their blood can attack islet cell autoantibodies, such as islet cell antibody (ICA), glutamic acid decarboxylase antibody (GADA), autoimmune damage make islet B cells suffer slow, function gradually decline, so the final control must rely on insulin treatment to maintain blood glucose. The mechanism of the incidence of diabetes is immune-mediated, which itself produces antibodies to destroy its own tissues and organs of the islet, and type 1 diabetes, but the incidence of late age, immune impairment is weak, the failure mode is slow and non sustainable development, and the latter is not as the same. Therefore, in 1999, according to the WHO recommendations, it was named as adult concealed (or late-onset) autoimmune diabetes mellitus (hereafter referred to as latent diabetes mellitus), belonging to the subtype of type 1 diabetes mellitus.


Diagnostic standard

Occult diabetic patients generally self diagnosis early to half a year or a few years, through diet, exercise and oral hypoglycemic drug treatment is effective, does not appear spontaneously and similar to type 2 diabetes ketosis. Therefore, it is almost impossible to distinguish it from type 2 diabetes by age, symptoms, efficacy, and other clinical conditions. At present, the diagnosis is no uniform standard, but the clinical often to refer to the following 3 points: 1. The age of onset of late adult stage; the diagnosis of diabetes was established, at least half a year is not dependent on insulin treatment; islet cell autoantibodies against the positive diagnosis of the decisive role played. Glutamic acid decarboxylase antibodies and islet cell antibodies were listed as the main diagnostic targets, and carboxypeptidase -H antibodies could be considered as new indicators. Among the many antibodies, glutamic acid decarboxylase antibody is the most sensitive and stable for a long time. It is convenient and easy to standardize. It has become a gold standard for diagnosis.

A beneficial treatment

Occult diabetes and other types of diabetes is consistent on the control strategies and objectives, namely the active treatment of blood glucose, reduce complications, slow development, protect the islet cells, delaying its failure. By contrast, however, occult diabetes is characterized by slow immune damage to islet B cells, thus protecting the remaining islet B cells is particularly important. However, it is not clear how the protection and treatment modalities are most beneficial. Thankfully, the medical researchers have shown that useful therapies are beginning to emerge:

Insulin can not only make islet B cells rest, reduce pancreatic islet antigen release and reduce the immune response, promote B cells to repair the remaining, can also regulate immune function, improve immune tolerance, inhibit the apoptosis of B cells. This is very beneficial to protect the residual B cells and delay the destruction of islet function.

Insulin sensitizing agents, such as metformin, do not interfere with the immune response of B cells and have hypoglycemic effects. In addition, rosiglitazone has potential anti-inflammatory and immunomodulatory effects, and can improve insulin resistance, promote insulin synthesis, and protect islet function.

Insulin releasing agents, such as sulfonylureas, stimulate insulin secretion and continue to stimulate the release of islet autoantigen, thereby activating the immune response and even accelerating the destruction of B cells. Therefore, hidden diabetes patients should avoid application.

As for the drug effects on the human immune system, such as immune inhibitors (cyclosporine A, Tripterygium wilfordii) and immunomodulator (BCG vaccine, GAD vaccine, etc.) to protect and improve islet function, regulating the immune cells also have a good effect, but also could be used in the clinic for further study.

Occult diabetes is not uncommon, accounting for about 10% of newly diagnosed type 2 diabetes mellitus. To this end, the initial onset of diabetes can be routinely detected islet cell autoantibodies, and strive to detect as soon as possible. Once diagnosed, insulin therapy should be used early to protect the remaining islet B cells.

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