Heterogenicity of type 2 diabetes mellitus: clinical characteristics of 4 subtypes

Abstract


Aim. To characterize clinically subtypes of type 2 diabetes mellitus (DM2) depending on lymphocyte reaction to insulin.
Material and methods. DM2 patients (n = 357) were divided into 4 groups: DM2a - direct response of lymphocytes to insulin (RLI) detected in lymphocyte blasttransformation reaction, ICA+; DM2b - indirect RLI detected at inhibition of cells with receptors to histamine with cimetidin, ICA+; DM2c - indirect RLI detected at inhibition of cells synthetizing prostaglandin with indometacine, ICA -; DM2d - the absence of RLI, ICA - .
Results. DM2a patients were characterized by 5-year need in insulin, development of microangiopathy. DM2b patients - by overweight, combination of micro- and macroangiopathy, high risk of stroke, myocardial infarction, diabetic foot, need in insulin. DM2c patients had classic DM2, they were not in need of insulin at early stages of the disease, with typical development of macroangiopathy. DM2d patients had pancreatogenic DM.
Conclusion. Application of the immunological criterion (type of RLI) differentiates DM2 patients with different course, prognosis. They need different treatment.

About the authors

Nailya Sayfullaevna Asfandiyarova

Email: n.asfandiyarova2010@yandex.ru

N S Asfandiyarova

Academician I.P. Pavlov State Medical University, Ryazan

Academician I.P. Pavlov State Medical University, Ryazan

References

  1. Асфандиярова H. C., Колчева Н. Г., Шатрова И. В., Гончаренко Л. В. Сравнительная иммунопатология сахарного диабета. Пробл. эндокринол. 1998; 6: 3-5.
  2. Асфандиярова Н. С., Колчева Н. Г., Шатрова И. В. О гетерогенности сахарного диабета. Тер. арх. 1999; 12: 49-52.
  3. World Health Organisation: Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO consultation. Part 1: Diagnosis and classification of diabetes mellitus. Geneva: World Health Organisation; 1999.
  4. Алехин E. K., Лазарева Д. Н., Сибиряк С. В. Иммунотропные свойства лекарственных средств. Уфа; 1993.
  5. Goodwin J. S., Bankhurst A. D., Messner R. P. Suppression of human T-cell mitogenesis by prostaglandin. J. Exp. Med. 1977; 146: 1719-1734.
  6. Балаболкин М. И. Сахарный диабет. M.: Медицина; 1994.
  7. Дедов И. И., Мельниченко Г. А., Фадеев В. В. Эндокринология. М: Медицина; 2007.
  8. Сунцов Ю. И., Дедов И. И., Кудрякова С. В. Государственный регистр сахарного диабета: эпидемиологическая характеристика инсулиннезависимого сахарного диабета. Сахар. диабет 1998; 1: 41-43.
  9. Arikan E., Sabuncu T., Ozer E. M., Hatemi H. The clinical characteristics of latent autoimmune diabetes in adults and its relation with chronic complications in metabolically poor controlled Turkish patients with type 2 diabetes mellitus. Diabet. Compl. 2005; 19: 254-258.
  10. Bottazzo J. F., Bosi E., Cull C. A. et al. IA-2 antibody prevalence and risk assessment of early insulin requirement in subjects presenting with type 2 diabetes (UKPDS 71). Diabetologia 2005; 48: 703-708.
  11. Di Mario U., Irvine W. J., Borsey D. Q. et al. Immune abnormalities in diabetic patients not requiring insulin at diagnosis. Diabetologia 1983; 25: 392-395.
  12. Falorni A., Brozzetti A. Diabetes-related antibodies in adult diabetic patients. Best Pract. Res. Clin. Endocrinol. Metab. 2005; 1: 119-133.
  13. Brooks-Worrell B. M., Greenbaum C. J., Palmer J. P., Pihoker C. Autoimmunity to islet proteins in children diagnosed with new onset diabetes. J. Clin. Endocrinol. 2004; 89: 2222-2227.
  14. Palmer J. P., Hampe C. S., Chiu H. et al. Is latent autoimmune diabetes in adults distinct from type 1 diabetes or just type 1 diabetes at an older age? Diabetes 2005; 54 (Suppl. 2): S62-S67.
  15. Asfandiyarova N. S. Ranitidin and Indometacin in the treatment of insulin resistance (abstr). Diabet. Vasc. Dis. Res. 2004; 1: 138.
  16. Netea M. G., Tack C. J., Netten P. M. et al. The effect of salicilates on insulin sensitivity. J. Clin. Invest. 2001; 108: 1723- 1724.
  17. Palme J. P., Hirsch I. B. What's in a name: latent autoimmune diabetes of adults, type 1.5, adult-onset, and type 1 diabetes (Editorial). Diabet. Care 2003; 26: 536-538.
  18. Brooks-Worrell B., Chiu H., Goel A., Palmer J. P. Similarities and differences in autoimmune response between type 1 and type 1,5 diabetes patients (abstr). Clin. Immunology 2005; Suppl. 1: Sal. 134.
  19. Orchard T. J., Olson J. C., Erbey J. R. et al. Insulin resistance-related factors, but not glycemia, predict coronary artery disease in type 1 diabetes. 10-year follow-up data from the Pittsburg Epidemiology of Diabetes Complications Study. Diabet. Care 2003; 26: 1374-1379.
  20. Thorn L. M., Forsblom C., Fagerudd J. et al. Metabolic syndrome in type 1 diabetes. Diabet. Care 2005; 28: 2019-2024.
  21. Asfandiyarova N. S., Kolcheva N. G., Ryazantsev I. V., Ryazantsev V. S. Risk factors for stroke in type 2 diabetes mellitus. Diabet. Vasc. Dis. Res. 2000; 3: 57-60.
  22. Hilier T. A., Pedula K. L. Complications in young adults with early-onset type 2 diabetes. Losing the relative protection of youth. Diabet. Care 2003; 26: 2999-3005.
  23. Hirsch I. B. Type-1-and-change diabetes (editorial). Clin. Diabet. 1999; 17: 146-154.

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