Autoimmunity markers in subjects with diabetes

Introduction. Diabetes is a growing social and epidemiological problem. Accordingly, the incidence of complications associated with diabetes can cause a persistent high percentage of diseases of the cardiovascular system, kidney and nervous systems, and impaired vision. Objective. The aim of the study was to evaluate the incidence of immunological markers in patients with type 1 diabetes and those with type 2 diabetes: the anti-GAD, ANA, AMA, ASMA, APCA and LKM, compared to healthy people. Another objective of the study was to evaluate the correlation between their presence and the degree of metabolic control in both groups. Materials and methods. The study comprised 100 subjects aged 25–75 years with a body mass index (BMI) between 20–30 kg / m2, hospitalized in the Department of Internal Diseases, Diabetology and Endocrinology, at the Medical University of Warsaw, with previously diagnosed diabetes who were assigned to one of 2 groups (50 subjects with type 1 diabetes and 50 subjects with type 2 diabetes). The control group consisted of 21 healthy individuals without the diagnosis of diabetes and a prediabetic state. All the study participants had the examined antibodies determined along with the panel of biochemical tests and neurological examination for diabetic neuropathy and fundus examination. Results. Anti-GAD antibodies were present in both groups of patients. Their presence was found in 30% of people with type 1 diabetes and in 16% of people with diabetes type 2. The presence of ANA antibodies was found in 24% of people with type 1 diabetes and 22% of people with type 2 diabetes. There was no correlation between the presence of ANA antibodies ANA and duration of diabetes. In the group of patients with type 1 diabetes, there was a correlation between the presence of ANA and the incidence of diabetic polyneuropathy. ASMA and APCA antibodies occurred with equal frequency in both studied groups (4% vs. 10%). There were no antibodies of AMA or anti-LKM in any of the patients. Conclusions. Marking of ANA antibodies in patients with type 1 diabetes may be a marker used to isolate a group of patients at risk of developing diabetic neuropathy. The presence of anti-GAD in type 2 diabetes may be a LADA marker which specifically marks the group of patients with type 2 diabetes, in whom there is a faster metabolic death of beta cells. The current classification of diabetes is vague, and in the near future it should be modified based on specific patient characteristics, phenotypic appearance, as well as the results of additional tests. Determination of antibodies AMA, ASMA, APCA and anti-LKM does not seem to be significant in the diagnosis of diabetes and its chronic complications

Ciężka hipoglikemia u pacjentów w starszym wieku z cukrzycą typu 2 oraz towarzyszącymi chorobami układu sercowo-naczyniowego

Background: Hypoglycaemia is a condition that occurs when blood glucose levels fall below 3.9 mmol/L (70 mg/dL), while hypoglycaemic coma is usually associated with glycaemia around 1.1 mmol/L (20 mg/dL). Recurrent severe hypoglycaemia may result in permanent neurological disorders and also has a negative impact on the cardiovascular system. Aim: To evaluate the causes of severe hypoglycaemia in elderly patients with type 2 diabetes and coexistence of cardiovascular history. Methods: We analysed retrospectively the history of 33 elderly patients with type 2 diabetes and coexistence of cardiovascular history, who were admitted to our clinic due to severe hypoglycaemia with loss of consciousness. The mean age of the patients was 76.0 ± 11.1 years, and the mean duration of diabetes was 12.0 ± 9.8 years. Glycated haemoglobin (HbA1c) was measured and the prevalence of cardiovascular diseases and therapeutic procedures were evaluated. Results: In the group of patients with severe hypoglycaemia, the mean value of HbA1c was 6.3 ± 1.2% (44 ± 13.1 mmol/mol), which indicates a mean glucose value below 7.8 mmol/L (140 mg/dL). Ischaemic heart disease was diagnosed in 18 patients (eight had a history of myocardial infarction), and 22 patients had arterial hypertension. Severe hypoglycaemia requiring hospitalisation in elderly patients with type 2 diabetes and coexistence of cardiovascular history was related to insulin or sulfonylurea therapy. Conclusions: A low HbA1c level indicates inappropriate intensification of therapy and was associated with high risk of severe hypoglycaemic episodes in older people. The majority of severe hypoglycaemic episodes were observed in sulphonylurea or insulin-treated type 2 diabetic patients.Wstęp: Hipoglikemię rozpoznaje się, jeżeli stężenie glukozy w surowicy obniży się poniżej 3,9 mmol/l (70 mg/dl), natomiast śpiączka hipoglikemiczna występuje zwykle przy stężeniach glukozy ok. 1,1 mmol/l (20 mg/dl). Nawracające ostre hipoglikemie mogą być przyczyną zaburzeń neurologicznych i mają negatywny wpływ na układ sercowo-naczyniowy. Cel: Celem pracy była ocena przyczyn ciężkiej hipoglikemii u pacjentów z cukrzycą typu 2 oraz z towarzyszącymi chorobami układu sercowo-naczyniowego (CVD). Metody: Przeanalizowano retrospektywnie historie chorób 33 pacjentów z cukrzycą typu 2 oraz z towarzyszącymi CVD, u których rozpoznano ciężką hipoglikemię z utratą świadomości. Średni wiek pacjentów wynosił 76,0 ± 11,1 roku, a czas trwania cukrzycy średnio 12,0 ± 9,8 roku. Oceniano stężenie hemoglobiny glikowanej (HbA1c), częstość występowania CVD oraz sposób postępowania terapeutycznego. Wyniki: U pacjentów z ciężką hipoglikemią średnie stężenie HbA1c wynosiło 6,3 ± 1,2% (44 ± 13,1 mmol/mol), co odpowiada średniemu stężeniu glukozy poniżej 7,8 mmol/l (140 mg/dl). Chorobę niedokrwienną serca stwierdzono u 18 osób (8 przebyło zawał serca), a u 22 pacjentów — nadciśnienie tętnicze. Ciężka hipoglikemia wymagająca hospitalizacji u pacjentów w starszym wieku z cukrzycą typu 2 oraz towarzyszącymi CVD wiązała się ze stosowaniem insuliny i pochodnych sulfonylomocznika. Wnioski: Niskie wartości HbA1c wskazują na nieodpowiednią intensyfikację leczenia, prowadzącą do epizodów ciężkiej hipoglikemii u pacjentów w starszym wieku. Większość stanów ciężkiej hipoglikemii występuje u osób z cukrzycą typu 2 leczonych preparatami insulin lub pochodnymi sulfonylomocznika