Risk of cardiac autonomic neuropathy in latent autoimmune diabetes in adults is similar to type 1 diabetes and lower compared to type 2 diabetes: A cross‐sectional study

Maddaloni, Ernesto; Moretti, Chiara; Toro, Rossella Del; Sterpetti, Sara; Ievolella, Maria Vittoria; Arnesano, Gabriele; Strollo, Rocky; Briganti, Silvia; D’Onofrio, Luca; Pozzilli, Paolo; Buzzetti, Raffaella

doi:10.1111/dme.14455

Cited by 10 publications

(16 citation statements)

References 40 publications

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“…Similarly, Maddaloni et al. noted that LADA patients had a lower risk of developing cardiac autonomic neuropathy than T2D patients ( 29 ). These evidences highlight the existence of an early therapeutic window in LADA to improve complication outcomes by implementing strict glycemic control.…”

Section: Discussionmentioning

confidence: 95%

Effects of Berberine Plus Inulin on Diabetes Care in Patients With Latent Autoimmune Diabetes in Adults: Protocol for a Randomized Controlled Trial

Zhang

Xiao

Yan³

et al. 2022

Front. Endocrinol.

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BackgroundLatent autoimmune diabetes in adults (LADA) is a heterogeneous form of diabetes, characterized by autoimmune destruction of pancreatic β-cells as well as insulin resistance and is triggered by environmental factors in the context of genetic susceptibility. Berberine (BBR), a small alkaloid isolated from medicinal plants, has antidiabetic, anti-inflammatory, and antibacterial effects. Inulin is a common prebiotic that has been shown to improve glycemic control, alter the gut microbiota and suppress inflammation. The primary purpose of this study was to evaluate the effects of oral BBR and inulin combined with insulin therapy on diabetes care in patients with LADA.Methods and AnalysisWe will conduct a single-center, prospective, randomized, double-blind, placebo-controlled trial. A total of 240 patients with LADA who have started insulin therapy will be randomly allocated either to the intervention or control group. After a 1-week run-in period, they will complete a 3-month treatment of BBR alone, inulin plus BBR, inulin alone, or placebo. Anthropometric and clinical data will be collected at five time points: baseline, 3 months, 6 months, 9 months, and 12 months from baseline. The primary outcome was the change in glycated hemoglobin levels. Dynamic blood glucose parameters, β-cell function, and gut microbiota, as well as adverse events and quality of life will be monitored.DiscussionGlycemic control is critical for preventing the progression of diabetes. Although insulin is a recommended treatment for patients with LADA, there are currently no drugs that can effectively prevent the progressive destruction of pancreatic β-cells or maintain their function. Several studies have found that when berberine and prebiotics are used alone, they have beneficial metabolic effects. This clinical research protocol will assess the efficacy of the combined treatment of berberine plus inulin and provide new ideas for future pharmacological research and clinical practices in diabetes care and glycemic control for LADA patients.Ethics and DisseminationThis study has been approved by the Ethics Committee of National Clinical Research Center of the Second Xiangya Hospital of Central South University (approval number: 2021–046).Clinical Trial RegistrationClinicalTrials.gov, identifier NCT04698330

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Section: Discussionmentioning

confidence: 95%

Effects of Berberine Plus Inulin on Diabetes Care in Patients With Latent Autoimmune Diabetes in Adults: Protocol for a Randomized Controlled Trial

Zhang

Xiao

Yan³

et al. 2022

Front. Endocrinol.

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“…Available data confirm that the risk of developing neuropathy varies according to metabolic control and disease duration 197,198 . The prevalence of cardiac autonomic neuropathy, a frequent, life-threatening and often overlooked complication of diabetes, is similar between people with young-onset diabetes and AOA diabetes, but lower than in those with T2DM 199,200 . No solid data comparing prevalence and features of diabetic foot between LADA and T2DM have been published so far.…”

Section: Microvascular Complicationsmentioning

confidence: 98%

Adult-onset autoimmune diabetes

Buzzetti

Maddaloni

Gaglia

et al. 2022

Nat Rev Dis Primers

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Diabetes mellitus is a disease characterized by high blood glucose levels. When the disease is associated with severe loss of insulin secretion, it is referred to as insulin dependent, as affected individuals need insulin therapy to survive. Conversely, if the disease is caused by less severe insulin deficiency, affected patients are not dependent on insulin. Disease forms in which certain immune signatures are present, such as peripheral blood islet-specific autoantibodies, are classified as autoimmune diabetes, that is, type 1 diabetes mellitus (T1DM) or, more accurately, type 1A diabetes to distinguish it from idiopathic type 1B diabetes 1 . In broad terms, individuals who present in childhood usually have insulin-dependent T1DM, but may also be affected by monogenic diabetes, known as maturity-onset diabetes of youth (MODY), or even type 2 diabetes (T2DM). Conversely, those who present in adulthood usually have non-insulin-dependent T2DM, but cases of adult-onset autoimmune (AOA) diabetes are also frequent. Adult-onset diabetes has been suggested to encompass five different phenotypic groups in which those phenotypes that present with islet-specific autoantibodies are classified together as severe autoimmune diabetes (SAID) 2 . The distinction between severe insulin deficiency, requiring insulin treatment, and more modest insulin deficiency, treatable by other means, is not always clear, especially in adult-onset diabetes 3 .Many of the issues surrounding adult-onset diabetes relate to the relationship between T1DM and T2DM in the context of age at onset, blood glucose levels and insulin deficiency, with lack of clear boundaries that define these major types of diabetes (Fig. 1). For example, although most cases of childhood-onset diabetes are autoimmune diabetes, most cases of autoimmune diabetes, in actual numbers, develop in adulthood. AOA diabetes is much more heterogeneous than young-onset autoimmune diabetes, as the rate of β-cell destruction is highly variable, probably owing to the differential presence of genetic factors and differing severity of the individual autoimmune process 4,5 .Epidemiological studies have highlighted that most patients with AOA diabetes do not require insulin treatment at diagnosis 6,7 , and these patients are commonly defined as having latent autoimmune diabetes in adults (LADA). In 2022, LADA has been included under the category of T1DM in the diabetes classification proposed by the American Diabetes Association (ADA), although the term retains its own identity, being defined as common and acceptable in everyday clinical practice, raising awareness of individuals at risk of progressing towards requiring insulin therapy 1 . As most studies in AOA diabetes referred to 'people with LADA' , we retain the term LADA in this Primer when appropriate. The inherent conundrum has implications for this interface between the two major types of diabetes, that is T1DM and T2DM, and how they should be treated in clinical practice.In this Primer, we discuss the epidemiology, pathogenesis, c...

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“…En cuanto a la neuropatía autonómica cardiovascular diabética (19), los pacientes con LADA presenta un riesgo similar al visto en la diabetes mellitus tipo 1, pero inferior al de la diabetes mellitus tipo 2 (20), asociado en potencia a estados hiperglucémicos prolongados y lesiones autoinmunitarias; y también tiene una menor mortalidad y menor riesgo de presentar eventos cardiovasculares en comparación a los pacientes con diabetes mellitus tipo 2 (21). Enfatizando aún más el punto intermedio que en apariencia constituye LADA frente a las dos principales formas de diabetes.…”

Section: Comorbilidadesunclassified

Perfil clínico metabólico en la diabetes autoinmune latente del adulto: consideraciones desde la atención primaria

Alcívar

Corcho

2022

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Introducción: la diabetes tipo LADA fue primitivamente identificada en 1977 por Irvine WJ y colaboradores, sin embargo, no fue hasta 1993 que Toumi y colaboradores introdujeron por primera vez el término. Actualmente no existe un consenso para definir con exactitud a LADA, así, la diabetes LADA es una forma de diabetes tipo 1 de lenta progresión que se caracteriza por presentar manifestaciones clásicamente asociadas a diabetes tipo 2, más la evidencia de anticuerpos contra las células b-pancreáticas, particularmente autoanticuerpos contra de ácido glutámico descarboxilasa. Objetivo: sintetizar las principales consideraciones de la diabetes tipo LADA desde el prisma de la atención primaria. Metodología: revisión bibliográfica de artículos y libros publicados en las bases de datos PubMed, ScienceDirect y ScieElo. En la búsqueda no sistemática se emplearon los términos y descriptores LADA; Diabetes autoinmune latente del adulto; y Latent autoinmume diabetes in adults; se emplearon los criterios de inclusión: antigüedad no mayor a 5 años, idioma español o inglés, incluir los tópicos fisiopatología, epidemiología, patogénesis, etiología, características clínicas, diagnóstico, comorbilidades, tratamiento y abordaje desde el primer nivel – prevención; y estar disponibles de forma gratuita. Tras la aplicación de los criterios de inclusión la búsqueda se redujo a 531 trabajos; de los que fueron seleccionados 35 a partir de la lectura rápida. Resultados: se construyó una revisión de la literatura que sintetiza los principales aspectos respecto a la diabetes LADA y orienta consideraciones elementales para su sospecha y abordaje en el primer nivel de salud. Conclusión: La diabetes tipo LADA es una forma de diabetes tipo 1 subdiagnosticada y con una incidencia mayor que la diabetes tipo 1 clásica; sospecharla y manejarla en el primer nivel de atención es una competencia de los profesionales de atención primaria, dada su incidencia, sin embargo, el diagnóstico debe ser realizado por un especialista en el área.

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Risk of cardiac autonomic neuropathy in latent autoimmune diabetes in adults is similar to type 1 diabetes and lower compared to type 2 diabetes: A cross‐sectional study

Cited by 10 publications

References 40 publications

Effects of Berberine Plus Inulin on Diabetes Care in Patients With Latent Autoimmune Diabetes in Adults: Protocol for a Randomized Controlled Trial

Effects of Berberine Plus Inulin on Diabetes Care in Patients With Latent Autoimmune Diabetes in Adults: Protocol for a Randomized Controlled Trial

Adult-onset autoimmune diabetes

Perfil clínico metabólico en la diabetes autoinmune latente del adulto: consideraciones desde la atención primaria

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