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Implicações clínicas da persistência de anti-GAD positivo e peptídeo C detectável em pacientes com diabetes melito tipo 1 de longa duração Translated title: GADA persistence and detectable C peptide in patients with long standing diabetes mellitus type 1

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      Abstract

      OBJETIVO: Avaliar se anti-GAD positivo e PC detectável se correlacionam com a presença de outras doenças autoimunes, com controle glicêmico e com risco de retinopatia no diabetes melito tipo 1 (DMT1) > 3 anos de duração. PACIENTES E MÉTODOS: Cinquenta sujeitos com DMT1 foram entrevistados, realizaram fundoscopia e dosaram PC pré e pós-glucagon, HbA1C e anti-GAD. RESULTADOS: Pacientes anti-GAD+ (n = 17) apresentaram maior frequência de doenças autoimunes em relação aos demais (p = 0,02). PC detectável (n = 11) também foi associado ao aumento dessa prevalência (p = 0,03), porém nenhum dos dois parâmetros influenciou na presença de retinopatia diabética. PC detectável não influenciou no controle glicêmico (HbA1C média) (p = 0,28), porém as doses diárias de insulina foram mais baixas (0,62 vs. 0,91 U/kg/dia; p = 0,004) neste grupo. CONCLUSÃO: Apesar de não ser um marcador para outras doenças autoimunes, o anti-GAD+ parece ser não só um sinalizador de autoimunidade pancreática. PC detectável também parece ter papel promissor na detecção dessas comorbidades. Ambos não interferiram na presença de retinopatia, entretanto, o PC detectável se relacionou a menores necessidades de insulina.

      Translated abstract

      OBJECTIVE: The aim of this study was to evaluate if GADA+ and detectable CP had any influence in other autoimmune diseases, glycemic control, and risks of retinopathy in diabetes mellitus type 1 (T1DM) lasting longer than 3 years of duration. SUBJECTS AND METHODS: Fifty T1DM subjects were interviewed, performed fundoscopic examination, and measured CP before and after glucagon, HbA1C, and GADA. RESULTS: GADA+ (n = 17) had a higher frequency of other autoimmune diseases when compared to GADA (p = 0.02). Detectable CP was also associated with a higher prevalence of these diseases (p = 0.03), although, retinopathy was not influenced by either one. Detectable CP had no influence in the glycemic control (mean HbA1C) (p = 0.28). However, insulin daily doses were lower in this group (0.62 vs. 0.91 U/kg/day; p = 0.004). CONCLUSION: Although not recommend as a marker of other autoimmune diseases, GADA+ seems to be not only a pancreatic autoimmunity signal. Detectable CP may also have some promising influence in detecting these diseases. Neither influenced the presence of retinopathy, but insulin daily requirements were smaller when CP was present.

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      Most cited references 31

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      Diagnosis and classification

       G Miller (2007)
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        Anti-GAD-positive patients with Type 1 diabetes mellitus have higher prevalence of autoimmune thyroiditis than anti-GAD-negative patients with Type 1 and Type 2 diabetes mellitus

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          The rise and fall of insulin secretion in type 1 diabetes mellitus

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            Author and article information

            Affiliations
            [1 ] Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione Brazil
            [2 ] Universidade Federal do Rio de Janeiro Brazil
            [3 ] Universidade Federal do Rio de Janeiro Brazil
            [4 ] Hospital Central da Aeronáutica Brazil
            [5 ] Hospital Central da Aeronáutica Brazil
            Contributors
            Role: ND
            Role: ND
            Role: ND
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            Role: ND
            Journal
            abem
            Arquivos Brasileiros de Endocrinologia & Metabologia
            Arq Bras Endocrinol Metab
            Sociedade Brasileira de Endocrinologia e Metabologia (São Paulo )
            1677-9487
            2010
            : 54
            : 5
            : 449-454
            S0004-27302010000500004 10.1590/S0004-27302010000500004

            http://creativecommons.org/licenses/by/4.0/

            Product
            Product Information: SciELO Brazil
            Categories
            ENDOCRINOLOGY & METABOLISM

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