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Comparaison de la gestion de l’hyperglycémie entre les personnes vivant avec le diabète auto-immun latent de l’adulte (pvLADA) et le diabète de type 1 (pvDT1) dans la cohorte canadienne BETTER
Résumé
Le LADA est un diabète atypique caractérisé par une destruction auto-immune des cellules Bêta du pancréas plus lente comparativement au DT1 classique, entrainant une confusion au diagnostic avec le diabète de type 2 (DT2). Lorsque l’insulinothérapie intensive devient nécessaire, la gestion du diabète est identique au DT1 pour la prévention des complications sérieuses (voire mortelles) telles que l’acidose hyperglycémique diabétique (ACD). Notre groupe a précédemment constaté des taux d’hospitalisations d’ACD plus élevés chez pvLADA dans la cohorte BETTER. Hypothèse : La gestion de l’hyperglycémie est moins optimale chez les pvLADA vs. pvDT1. Objectif : Explorer les différences dans la gestion de l’hyperglycémie entre les pvLADA et pvDT1. Méthode : Une étude transversale observationnelle des données auto-rapportées en ligne des participants de BETTER. Résultats : Parmi 3855 participants, 10% (384) ont rapporté un diagnostic de LADA. Les pvLADA vs pvDT1 étaient plus âgés 50,2±12,6ans vs. 40,4±15,9ans (p<0,001); présentaient une moindre durée de diabète 9,1±8,6ans vs. 22,4±15,6ans (p<0,001) et ont été hospitalisés pour ACD plus fréquemment dans la dernière année 9.0% vs 5% (p=0,027). Moins de pvLADA que pvTD1 exécutaient des actions qui préviennent l’hyperglycémie (p<0,05); notamment, à taux de sucre élevé ≥20mmol/L : 62% vs 89% (p<0,001) s’injectaient de l’insuline et 52% vs 60% (p=0,017) buvaient de l’eau, 50% vs 63% (p=0,005) vérifiaient attentivement leur glycémie. Conclusion: L’insulinothérapie et les actions préventives de l’ACD semblent moins optimales chez les pvLADA. Améliorer la formation sur la gestion de l’hyperglycémie et explorer les raisons, telles que la confusion avec DT2 influençant les habitudes de gestion, sont essentielles en LADA.
Références bibliographiques
1. Kreider KE, Gabrielski AA, Hammonds FB. Hyperglycemia Syndromes. Nurs Clin North Am. 2018;53(3):303-17.
2. Chiasson JL, Aris-Jilwan N, Bélanger R, Bertrand S, Beauregard H, Ekoé JM, et al. Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state. CMAJ. 2003;168(7):859-66.
3. Maahs DM, Hermann JM, Holman N, Foster NC, Kapellen TM, Allgrove J, et al. Rates of Diabetic Ketoacidosis: International Comparison With 49,859 Pediatric Patients With Type 1 Diabetes From England, Wales, the U.S., Austria, and Germany. Diabetes Care. 2015;38(10):1876-82.
4. Dhatariya KK. Defining and characterising diabetic ketoacidosis in adults. Diabetes Res Clin Pract. 2019;155:107797.
5. Fayfman M, Pasquel FJ, Umpierrez GE. Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. Med Clin North Am. 2017;101(3):587-606.
6. Carlsson S. Etiology and Pathogenesis of Latent Autoimmune Diabetes in Adults (LADA) Compared to Type 2 Diabetes. Front Physiol. 2019;10:320.
7. Buzzetti R, Tuomi T, Mauricio D, Pietropaolo M, Zhou Z, Pozzilli P, et al. Management of Latent Autoimmune Diabetes in Adults: A Consensus Statement From an International Expert Panel. Diabetes. 2020;69(10):2037-47.
8. Fourlanos S, Dotta F, Greenbaum CJ, Palmer JP, Rolandsson O, Colman PG, et al. Latent autoimmune diabetes in adults (LADA) should be less latent. Diabetologia. 2005;48(11):2206-12.
9. Brazeau AS, Messier V, Talbo MK, Gagnon C, Taleb N, Fortier I, et al. Self-reported Severe and Nonsevere Hypoglycemia in Type 1 Diabetes: Population Surveillance Through the BETTER Patient Engagement Registry: Development and Baseline Characteristics. Can J Diabetes. 2022;46(8):813-21.
10. Dhatariya K. Blood Ketones: Measurement, Interpretation, Limitations, and Utility in the Management of Diabetic Ketoacidosis. Rev Diabet Stud. 2016;13(4):217-25.
11. Nguyen É, Wong K, Lalanne-Mistrih M-L, Rabasa-Lhoret R, Brazeau A-S. Association between low-carbohydrate-diet score, glycemia and cardiovascular risk factors in adults with type 1 diabetes. Nutrition, Metabolism and Cardiovascular Diseases. 2024;34(9):2143-54.
12. Singh H, Gonder-Frederick L, Schmidt K, Ford D, Vajda K, Hawley J, et al. Assessing Hyperglycemia Avoidance in People with type 1 Diabetes. Diabetes Management. 2014;4:263.
13. Weinstock RS, Xing D, Maahs DM, Michels A, Rickels MR, Peters AL, et al. Severe Hypoglycemia and Diabetic Ketoacidosis in Adults With Type 1 Diabetes: Results From the T1D Exchange Clinic Registry. The Journal of Clinical Endocrinology & Metabolism. 2013;98(8):3411-9.
14. Bradford AL, Crider CC, Xu X, Naqvi SH. Predictors of Recurrent Hospital Admission for Patients Presenting With Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State. J Clin Med Res. 2017;9(1):35-9.
15. Del Degan S, Dubé F, Gagnon C, Boulet G. Risk Factors for Recurrent Diabetic Ketoacidosis in Adults With Type 1 Diabetes. Canadian Journal of Diabetes. 2019;43(7):472-6.e1.
16. Randall L, Begovic J, Hudson M, Smiley D, Peng L, Pitre N, et al. Recurrent diabetic ketoacidosis in inner-city minority patients: behavioral, socioeconomic, and psychosocial factors. Diabetes Care. 2011;34(9):1891-6.
17. Imam SK, Hassan FM, Mohamed H. Latent Autoimmune Diabetes in an Adult Male Presenting With Diabetic Ketoacidosis (DKA). Cureus. 2023;15(1):e33847.
18. Bergenstal RM, Tamborlane WV, Ahmann A, Buse JB, Dailey G, Davis SN, et al. Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. N Engl J Med. 2010;363(4):311-20.
19. Ghazanfar H, Rizvi SW, Khurram A, Orooj F, Qaiser I. Impact of insulin pump on quality of life of diabetic patients. Indian J Endocrinol Metab. 2016;20(4):506-11.
20. Karges B, Schwandt A, Heidtmann B, Kordonouri O, Binder E, Schierloh U, et al. Association of Insulin Pump Therapy vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, and Glycemic Control Among Children, Adolescents, and Young Adults With Type 1 Diabetes. JAMA. 2017;318(14):1358-66.
21. Farsani SF, Brodovicz K, Soleymanlou N, Marquard J, Wissinger E, Maiese BA. Incidence and prevalence of diabetic ketoacidosis (DKA) among adults with type 1 diabetes mellitus (T1D): a systematic literature review. BMJ Open. 2017;7(7):e016587.
22. Pickup JC. Management of diabetes mellitus: is the pump mightier than the pen? Nat Rev Endocrinol. 2012;8(7):425-33.
23. Butalia S, Johnson JA, Ghali WA, Rabi DM. Clinical and socio-demographic factors associated with diabetic ketoacidosis hospitalization in adults with Type 1 diabetes. Diabet Med. 2013;30(5):567-73.
24. Heinemann L, Fleming GA, Petrie JR, Holl RW, Bergenstal RM, Peters AL. Insulin pump risks and benefits: a clinical appraisal of pump safety standards, adverse event reporting, and research needs: a joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group. Diabetes Care. 2015;38(4):716-22.
25. Wu Z, Rabasa-Lhoret R, Messier V, Shohoudi A, Dasgupta K, Pelletier J, et al. Self-reported haemoglobin A1c highly agrees with laboratory-measured haemoglobin A1c among adults living with type 1 diabetes: A BETTER registry study. Diabetes Metab. 2022;48(1):101277.
Auteurs
I. Baseme Samuna (1), M. Nehme (1), M. Talbo (2), V. Messier (2), N. Taleb (1)<br> (1) Crchum, Montréal, Canada, (2) Ircm, Montréal, Canada