Tykhonova T. Slowly progressing autoimmune diabetes in adults: stages of the disease development, clinical immunological and genetic markers, establishment of the pathogenetic therapy.

It had been set a clinicopathogenetic independence of SPADA and expediency of allocation of this variant of the disease as a separate form of DM based on a comprehensive survey of patients with slowly progressing autoimmune diabetes in adults (SPADA), type 1 and 2 diabetes mellitus (DM) with the study of immunological, hormonal, metabolic parameters, and genetic markers. A mathematical model which allows to define the risk groups of possible SPADA presence was recommended on the basis of the comparative analysis of the anamnestic data of patients with the SPADA, Type 1 and Type 2 DM. To verify this form of the diabetes it was established the necessity of at least two antibody tests. The identification of GAD ab and/or IA-2 ab is established to be most demonstrative. The particularities of metabolic disorders in patients with SPADA were identified. The significant microvascular complications in patients with SPADA have been determined even with a short-term diabetes anamnesis. A high frequency of autoimmune thyroiditis and hypothyroidism in SPADA patients was established. It was determined that the dysglycemia in patients with SPADA is due to decreased production of insulin and the presence of insulin resistance. It was established the heterogeneity of SPADA patients accompanied by metabolic syndrome in 20,66 %. Cell and humoral immunity disorders were detected in the development of SPADA. The association of С1858Т of PTPN22 gene, A49G of CTLA4 gene and Е23К of KCNJ1gene polymorphisms with this form of disease was established. Children of endogamous marriages are included into the group with the high risk of SPADA development. It was proved the necessity of the early prescription of the insulin therapy to the patients with this form of DM.