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Clinical, hormonal and metabolic features of the primary determined diabetus mellitus in patients aged 30 – 45 years old


Author: Alexa Zinaida
Degree:doctor of medicine
Speciality: 14.00.03 - Endocrinology
Year:2008
Scientific adviser: Zinaida Anestiadi
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution:

Status

The thesis was presented on the 24 September, 2008
Approved by NCAA on the 23 October, 2008

Abstract

Adobe PDF document – 0.24 Mb / in romanian

Thesis

CZU 616.379-008.64-053.086-08+615.252

Adobe PDF document 0.67 Mb / in romanian
124 pages

Keywords

diabetes mellitus: type 1, type 2, diabet autoimmune, latent autoimmune diabetes in adults (LADA), residual β-cell function, insulin secretion, insulin dependent, insulin resistance, autoantibodies, ICA, GAD, autoantibodies to thyroid cell, metabolic control, hypoglycemic tretment, insulin therapy.

Summary

This study was carried out on the group of 140 persons, in 109 persons special investigations were performed (determination of the plasmatic levels of C-peptide, HbA1c, ICA and GAD antibodies titres). These investigations helped to determine the presence of the eventual modifications in β cells secretrory function, confirmed or excluded the autoimmune component in the diabetes pathogenesis, evaluated the severity metabolic modifications.

Type 1 diabetes was met in 24,7%, type 2 diabetes – in 56,2% cases and LADA presence was determined in 19,1% patients. Clinical presentation of LADA was similar to the type 2 diabetes. Arterial pression have demonstrated a certain tendency to reduction in the diabetes mellitus type 1 patients, but in patients with LADA and, especially, in ones with type 2 diabetes, arterial pression were increased. The patients with LADA had the BMI values intermediate between type 1 and type 2 diabetes patients.

In patients with type 1 diabetes the values of C-peptide were the least, that confirms the presence of absolute insulinic deficiency in these patients. In type 2 diabetes a certain tendency to hyperinsulinism was determined. Intermediate values of C-peptide were characteristic to LADA patients. Immunological markers such as ICA and GAD antibodies confirmed the autoimmune genesis of diabetes, therefore identifying the LADA presence.

The deepest modifications in both carbohydrate and lipid metabolsim were determined in type 1 diabetes. There was no statistic difference in carbohydrate metabolism modifications as well as in HbA1c values between patients with LADA and type 2 diabetes (P>0,05). The glycemia normalization both in patients with LADA and type 1 diabetes was accompanied by lipid spectrum normalization. In type 2 diabetes the good glycemic control was nevertheless associated with the persistence of increased cholesterol and triglyceride but decreased HDL cholesterol values. In LADA patients antiTPO was determined in 35,3% cases, confirming the thyroid pathology association.

Taking into account the autoimmune genesis of LADA this group of patients must be from the very beginning treated with insuline, that in this case exerts not only metabolic, but as well the β cell protective action.

Primary determined diabetus mellitus in patients aged 30-45 years old represents a heterogenic disease, clinically comprising such forms as type 1, type 2 diabetes and LADA. Clinico-paraclinical differentiation of LADA will contribute to its timely diagnosis and the adminstration of the adequate etiopathogenetic therapy, that will significantly reduce the early and long-term complications.