A Case of Late Diagnosis of Latent Autoimmune Diabetes in Adults

Costa, Joana; Mestre, Ana; Miranda, Mariana Souto; Ferreira, Frederica H; Abuowda, Yahia

doi:10.7759/cureus.21826

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…According to a study, patients of LADA showed lower triglycerides and higher HDL cholesterol level as compared to Type 2 Diabetes mellitus. 11 Lastly, DIC seen in this case can be attributed to the previous history of multiple blood transfusions done in the last 1 year. Recognizing Zieve's syndrome promptly is crucial to prevent unwarranted and potentially detrimental interventions.…”

Section: Discussionmentioning

confidence: 69%

An unusual case of Zieve's syndrome in a 36‐year‐old male with latent autoimmune diabetes of adult and disseminated intravascular coagulation

Zalavadiya,

Bhatt,

Nagori

et al. 2024

Clinical Case Reports

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Key Clinical MessageZieve's syndrome, associated with chronic alcoholism, manifests as hemolytic anemia, transient hyperlipidemia, and cholestatic jaundice. Key symptoms comprise nausea, abdominal pain, and jaundice. Diagnosis relies on recognizing the triad in those with an alcohol use history. Supportive management includes blood transfusions and alcohol cessation. The exact pathophysiology remains uncertain, with hypotheses ranging from alcohol‐induced liver damage to autoimmune processes. The report emphasizes diagnostic complexities, particularly when concurrent with autoimmune disorders such as latent autoimmune diabetes of adults or complicated by disseminated intravascular coagulation (DIC). A 36‐year‐old male with latent autoimmune diabetes of adults and an 18‐year history of chronic alcoholism presented with yellowish skin discoloration, abdominal pain, and distension. Physical examination revealed signs of anemia, jaundice, pedal edema, hepatomegaly, splenomegaly, and abdominal tenderness. Over eight admissions, multiple tests revealed severe anemia, thrombocytopenia, elevated bilirubin, and positive autoantibodies. Treatment for suspected autoimmune hepatitis showed no improvement. Subsequent examinations indicated DIC, altered liver function, and cirrhosis progression. A confirmed diagnosis of Zieve's syndrome was made. Upper gastrointestinal endoscopy was done to check for esophageal varices which were banded. The patient was subsequently managed on supportive treatment with multiple blood transfusions and abstinence from alcohol. Prompt recognition of Zieve's syndrome is crucial to avoid unnecessary interventions. Alcohol cessation is the keystone of treatment, emphasizing the need to raise awareness among practitioners. This case points toward the importance of comprehensive evaluation, serial investigations, and multidisciplinary collaboration for accurate diagnosis and management. Further research is needed to enhance understanding and optimize therapeutic strategies.

show abstract

Section: Discussionmentioning

confidence: 69%

An unusual case of Zieve's syndrome in a 36‐year‐old male with latent autoimmune diabetes of adult and disseminated intravascular coagulation

Zalavadiya,

Bhatt,

Nagori

et al. 2024

Clinical Case Reports

View full text Add to dashboard Cite

show abstract

“…According to studies, despite the fact that they resemble type 1 diabetes patients in this regard, it was found that LADA patients have greater C peptide levels than individuals with adult-onset type 1 diabetes even after 10 years of diabetes. These patients also required insulin therapy earlier as compared to that of Type 2 diabetes patients ([ 8 , 9 , 11 , 12 ]).…”

Section: Discussionmentioning

confidence: 99%

“…The table below shows the major key points and comparison between Type 1, Type 2 DM, LADA and our case [ 12 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic camouflage: A case report on Latent autoimmune diabetics of adulthood

Neupane¹,

Jaishi²,

Koirala³

et al. 2022

Annals of Medicine &Amp; Surgery

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When Serum C-Peptide Measurement Drives Adequate Diabetes Mellitus Diagnosis and Therapy: A Case Report

Piazzolla

Lisco

Volpe

et al. 2023

EMIDDT

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Background: Therapeutic targets in type 2 diabetes mellitus (T2D) are oriented towards nephron- and cardio-protection and the prescription of antihyperglycemic agents with proven renal and cardiovascular benefits are increasing over time. Failure to promptly diagnose insulinopenic diabetes may adversely affect the adequacy of treatment and have harmful consequences, including severe hyperglycemia and diabetic ketoacidosis. Case report: Herein we present the case of a 57-year-old woman referred to our clinic due to poor glycemic control (HbA1c 80 mmol/mol, therapeutic target <53 mmol/mol), class III obesity (BMI 41 kg/m2; normal value <25 kg/m2), and high cardiovascular risk misdiagnosed with T2D several years before. C-peptide measurement (0.3 ng/dL; reference range 1.1 – 4.4 ng/mL) confirmed the diagnosis of an insulinopenic form of diabetes, and islet autoimmunity consequently measured (GADA 2,000 UA/mL, reference range <5 UA/mL; IA2 17.1 UA/mL, reference range <7.5 UA/mL) and defined the diagnosis of an autoimmune form of diabetes. Discussion: Deprescribing insulin therapy in T2D patients in favor of other antihyperglycemic medications has become a growing therapeutic opportunity to provide adequate glucose control, promote weight loss, improve insulin sensitivity, and ameliorate cardiovascular and renal outcomes. However, due to immediate problems, a blunted insulin reserve poses a significant restriction on the prescription of non-insulin agents (e.g., diabetic ketoacidosis due to gliflozins). According to our experience, the routine testing of insulin reserve provides detailed information on diabetes pathophysiology with positive implications for the appropriateness of pharmacological prescriptions. Conclusion: As part of our routine evaluation of diabetic patients, C-peptide measurement is a valuable and inexpensive tool to reclassify diabetes types and provide more appropriate disease management.

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A Case of Late Diagnosis of Latent Autoimmune Diabetes in Adults

Cited by 3 publications

References 19 publications

An unusual case of Zieve's syndrome in a 36‐year‐old male with latent autoimmune diabetes of adult and disseminated intravascular coagulation

An unusual case of Zieve's syndrome in a 36‐year‐old male with latent autoimmune diabetes of adult and disseminated intravascular coagulation

Diagnostic camouflage: A case report on Latent autoimmune diabetics of adulthood

When Serum C-Peptide Measurement Drives Adequate Diabetes Mellitus Diagnosis and Therapy: A Case Report

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