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Insulin dependence: problems with the classification of 100 consecutive patients
Summary
This study found that while islet cell antibodies and HLA DR3/DR4 heterozygosity are common in younger patients needing insulin, they also appear in older adults. These markers indicate earlier diagnosis and more severe symptoms at onset.
Area of Science:
- Endocrinology
- Immunogenetics
- Diabetes Mellitus Research
Background:
- Assessing clinical and immunogenetic factors in adult patients requiring insulin therapy.
- Distinguishing between patient groups based on specific immunogenetic markers.
Purpose of the Study:
- To evaluate the clinical and immunogenetic characteristics of 100 outpatients needing insulin.
- To investigate the prevalence of islet cell antibodies and HLA DR3/DR4 heterozygosity in different age groups.
Main Methods:
- Clinical evaluation of 100 adult outpatients and 15 inpatients requiring insulin.
- Immunogenetic analysis including islet cell antibodies and HLA DR3/DR4 typing.
- Follow-up of outpatients for at least one year.
Main Results:
- Fifty-six percent of outpatients had islet cell antibodies and/or HLA DR3/DR4 heterozygosity (Group A).
- Group A patients were younger at diagnosis, had shorter symptom duration, were more likely to have ketonuria, and had lower C-peptide levels.
- Immunogenetic markers were less prevalent in patients over 40 but did not differentiate them clinically from younger patients.
Conclusions:
- Islet cell antibodies and HLA DR3/DR4 heterozygosity are significant indicators in patients requiring insulin, particularly those diagnosed under 40.
- These markers are present in older adults as well, suggesting a broader role in insulin-requiring diabetes.
- Clinical presentation and long-term outcomes (control, insulin dose) were similar between immunogenetically defined groups.