Main Article Content
Background. Latent autoimmune diabetes in adults (LADA) is a heterogeneous type of diabetes mellitus (DM) that combines symptoms of type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Data about the frequency and structure of microvascular complications in LADA are small and quite contradictory, there is almost no information about the peculiarities of their course, which indicates the need for research in this area. Therefore, the purpose of the study was to determine the characteristics of diabetic kidney disease (DKD) in patients with latent autoimmune diabetes in adults compared with classical types of DM. Materials and methods. The study enrolled 112 patients with DM with DKD. Patients were divided into three groups: I — 54 people with LADA, II — 30 patients with T1DM, III — 28 patients with T2DM. Peculiarities of DKD course were studied based on the anamnesis data, clinical examination, glomerular filtration rate (GFR) values, albuminuria, albumin-creatinine ratio. Results. According to the anamnesis the diagnosis of DKD in patients with LADA was established on average 3 years after the manifestation of diabetes, which is 4.5 years earlier than in T1DM but 1.3 years later than in T2DM. The analysis of GFR stages showed that in LADA the category G3 was the most often (63 %) (G3a — in 46 %, G3b — in 17 %). The other patients had G1 stage (7 %), G2 stage (24 %), and only 6 % of patients had G4 stage. The albuminuria categories A1 and A2 predominated in patients of all groups (in LADA — 43 % of people in each category), while category A3 in LADA was registered twice as often as in T1DM. In LADA, the predominant phenotypes were non-albuminuric renal impairment (NARI) (43 %) and albuminuric phenotype (AP) (35 %), in T1DM — AP (50 %) and NARI (40 %), and in T2DM, all three phenotypes were registered with almost the same frequency (AP — in 32 %, NARI — in 29 %, progressive renal decline — in 39 %). Conclusions. The course of diabetic kidney disease in patients with latent autoimmune diabetes in adults differs from that in the classic types of diabetes, which indicates the need to develop a specific algorithm for this cohort of patients.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
Hawa MI, Kolb H, Schloot N, et al; Action LADA consortium. Adult-onset autoimmune diabetes in Europe is prevalent with a broad clinical phenotype: Action LADA 7. Diabetes Care. 2013 Apr;36(4):908-13. doi:10.2337/dc12-0931.
Buzzetti R, Tuomi T, Mauricio D, et al. Management of Latent Autoimmune Diabetes in Adults: A Consensus Statement From an International Expert Panel. Diabetes. 2020 Oct;69(10):2037-2047. doi:10.2337/dbi20-0017.
Jiang G, Luk AOY, Tam CHT, et al; Hong Kong Diabetes Register TRS Study Group. Progression of diabetic kidney disease and trajectory of kidney function decline in Chinese patients with Type 2 diabetes. Kidney Int. 2019 Jan;95(1):178-187. doi:10.1016/j.kint.2018.08.026.
Maddaloni E, Lessan N, Al Tikriti A, Buzzetti R, Pozzilli P, Barakat MT. Latent Autoimmune Diabetes in Adults in the United Arab Emirates: Clinical Features and Factors Related to Insulin-Requirement. PLoS One. 2015 Aug 7;10(8):e0131837. doi:10.1371/journal.pone.0131837.
Yasui J, Kawasaki E, Tanaka S, et al; Japan Diabetes Society Committee on Type 1 Diabetes Mellitus Research. Clinical and Genetic Characteristics of Non-Insulin-Requiring Glutamic Acid Decarboxylase (GAD) Autoantibody-Positive Diabetes: A Nationwide Survey in Japan. PLoS One. 2016 May 13;11(5):e0155643. doi:10.1371/journal.pone.0155643.
Fadiga L, Saraiva J, Catarino D, Frade J, Melo M, Paiva I. Adult-onset autoimmune diabetes: comparative analysis of classical and latent presentation. Diabetol Metab Syndr. 2020 Dec 3;12(1):107. doi:10.1186/s13098-020-00616-1.
Pugliese G, Penno G, Natali A, et al; Italian Diabetes Society and the Italian Society of Nephrology. Diabetic kidney disease: New clinical and therapeutic issues. Joint position statement of the Italian Diabetes Society and the Italian Society of Nephrology on "The natural history of diabetic kidney disease and treatment of hyperglycemia in patients with type 2 diabetes and impaired renal function". Nutr Metab Cardiovasc Dis. 2019 Nov;29(11):1127-1150. doi:10.1016/j.numecd.2019.07.017.
Ekinci EI, Jerums G, Skene A, et al. Renal structure in normoalbuminuric and albuminuric patients with type 2 diabetes and impaired renal function. Diabetes Care. 2013 Nov;36(11):3620-6. doi:10.2337/dc12-2572.