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Časopis Internal medicine – Článok Case study of a patient with diabetes mellitus type 2, metabolic syndrome and development of latent autoimmune diabetes in adults witch brought thoughts and questiones

Internal medicine

Peer - Reviewed Postgraduate Medical Journal.
Period 11x per year (july - august double issue)
1335-8359
The journal is indexed in the Slovak National Bibliography, Bibliographiia Medica Slovaca (BMS) and listed to citation database CiBaMed. All articles are reviewed. The publisher does not bear any responsibility for data and opinions of particular authors of the articles or advertisements. The articles on grey pages are company promotions or non reviewed information, an author is responsible for the content. Any reproduction of the content is allowed only with direct consent of the editorial office.
Predplatné
Internal medicine
Internal medicine
Peer - Reviewed Postgraduate Medical Journal.
Period 11x per year (july - august double issue)
Predplatné
Téma: Case studies

Case study of a patient with diabetes mellitus type 2, metabolic syndrome and development of latent autoimmune diabetes in adults witch brought thoughts and questiones

Daniel Kolény

Case study describes a patient with latent autoimmune diabetes of adults (LADA), who was treated for diabetes
mellitus type 2 (DMT2) with oral antidiabetic drugs (OAD) and insulin, considering normal level of C-peptide, age
and clinical signs of insulin resistance. Questionable is, when this type of diabetes needs to be considered. While
criteria for DMT 1 and 2 are accurately defined, for LADA the definition is not so clear. According to American Diabetes
Association (ADA) from 2017 for classification and diagnostics, DMT1 suggests in adults more variable clinical
picture, often without clinical symptomatology and ketoacidosis. Authors state incidence LADA in age of 30-
50, BMI in normal/mild overweight region, maintained residual secretion of insulin and positivity of autoantibodies.
Further there can be signs of hyperglycemia with requirement of insulin from 6 months to 6 years. Monitoring and
interpretation of C-peptide levels is fundamental, additional examination includes antibodies against glutamic acid
decarboxylase (GADA). However, the level of C-peptide and GADA at which DMT2 shifts to LADA is uncertain. By
the change of classification, also indication limitations for GLP1 (glucagon like peptid) are altered in OAD treatment.
At the time of minimal C-peptide secretion (0,030 nmol/l) th study patient except insulin and methformin took also
empagliflosin with good effect on stated parameters (HbA1c; dose of insulin; body weight -5 kg). In spite of that the
treatment with SGLT2 cotransport inhibitor and Mtf had to be cancelled. Studies published up to now, where both
SGLT2 inhibitor and placebo were used, showed statistically significant decline of HbA1c, number of patients reached
HbA1c < 7,0%, postprandial glycemia decreased, also body weight and insulin doses units. That is why they
appear to have good perspective in treatment of DMT1. Some molecules have proven cardioprotective (empagliflozin,
metformin, liraglutide) and nephroprotective (empagliflozin) effect in DMT2 patients. Whether they have this
positive effect also by DMT1/LADA is yet to be show in further studies. I will then have an answer whether I could
improve prognosis of study patient with proven coronary disease of heart.

latent autoimmune diabetes mellitus in adults (LADA), diabetes mellitus type 1 (DMT1), SGLT2 inhibitors, analogue GLP1, metformin
Interná med. 2018; 18 (6): 295-299

Ročník 2018  Témy časopisu Internal medicine 6 / 2018

Overview works

Laura Gombošová
Ľubomír Tomáš
Slavomíra Valachová, Eva Bullová, Ľubica Finďová
Ľubomír Skladaný, Silvia Kassová, Juraj Šváč
Erika Komanová
Iveta Wildová, Ladislav Šinkovič, Mojmír Ducár, Marianna Bystrianska

Case studies

Daniel Kolény
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3. LIPID Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-1357.
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Period 11x per year (july - august double issue)
1335-8359
The journal is indexed in the Slovak National Bibliography, Bibliographiia Medica Slovaca (BMS) and listed to citation database CiBaMed. All articles are reviewed. The publisher does not bear any responsibility for data and opinions of particular authors of the articles or advertisements. The articles on grey pages are company promotions or non reviewed information, an author is responsible for the content. Any reproduction of the content is allowed only with direct consent of the editorial office.
Predplatné
Internal medicine
Internal medicine
Peer - Reviewed Postgraduate Medical Journal.
Period 11x per year (july - august double issue)
Predplatné