.

.
&

 ...

WHO (WORLD HEALTH
ORGANIZATION) 1965

<130mg/dl, 2
( OGTT 50
100gr.). < 45 ,
,
, .
1979
NATIONAL DIABETES DATA GROUP (NDDG)
140 mg/dl, 2 OGTT, 75g
200 mg/dl, .
1980 1985 WHO.
WHO
ADA 1997 WHO 1999
ADA.
2003 IFG 100-125mg/dl.
2010 ADA
ADA, WHO EASD 1c>6,5
,
. 2011 1c>6,4
ADA

 [...] 1997

.. 1 ( 5-15%)
.. 2 ( 85-95%)
. &
( MODY: 1-2% ..2
LADA: 10% ..2)

.. (0,15-15% - 4-7%)

 1 (1)
,
. 7%

.
.
, , ,
.


.

,
.
c-
, .

2

:
GADA (glutamic acid decarboxylase abs),
ICA (islet cells abs),
IA-2 (insulinoma -associated protein 2 abs),
IAA (insulin antibodies)
5%
( persistently autoantibody negative),
1
.

2
1. 2

.
2
10
. ,

.
,
1 .

Insulin secretion (pmol/min)

2
800

700

600
500
400
300
200
100
0
0600

1000

1400

1800
Time

Adapted from Polonsky KS et al. NEJM 1996;334(12):777-83.

2200

0200

0600

 1 2
,

35

2
2
1

1 2
..2 (90-95%)

..1 (5-10%)
-

- (60-80%)

- <30 (~50% <15 )

- >40 ?

- - / I.A
-

- :

- (+):

- : (-)

GAD, ICA, IA-2A, IAA

- HLA (+): DR3, DR4,DQB1 0201,

*

- -: <10%

*0302

- LA: (-)
- - : 40-50%
ADA. Diabetes Care 2004; 27(suppl 1): S5-S10

 LADA (Latent autoimmune

Diabetes of adults)

>30 .
1

6
.
(- GAD)
HLA-DRB1*03, HLA-DRB1*04
Clark A.M.Desai Diabetologia 2006

 35-60
1

-GAD

LADA
C-

HLA DR-DQ

LADA

.
Interventions for latent autoimmune diabetes (LADA) in adults.
Brophy S, Davies H, Mannan S, Brunt H, Williams R.
Source, 2011 Sep 7;9:CD006165
College of Medicine, University of Wales, Swansea, Singleton Park, Swansea,
Wales, UK, SA2 8PP.

SEARCH STRATEGY: Studies were obtained from searches of electronic databases,

supplemented by handsearches, conference proceedings and consultation with experts.
Date of last search was December 2010.
SELECTION CRITERIA: Randomised controlled trials (RCT) and controlled clinical
trials (CCT) evaluating interventions for LADA or type 2 diabetes with antibodies
were included.

Two studies show SU leading to earlier insulin dependence

and a meta-analysis of four studies with considerable
heterogeneity showed poorer metabolic control if SU is
prescribed for patients with LADA compared to insulin. One
study showed that vitamin D with insulin may protect
pancreatic beta cells in LADA. Novel treatments such as
GAD65 in certain doses (20 g) have been suggested to
maintain fasting and stimulated C-peptide levels. However,
there is no significant evidence for or against other lines of
treatment of LADA.

 -
2

LADA

30-90
>40

35-75
35-75

0-35
<20

80%

10%

10%

GAD,ICA IA-2

OXI

NAI (35%)

NAI ( 64%)

HLA

Exp Clin Endocrinol Diabetes 2001

The Genetic Causes of ( )

Maturity Onset Diabetes of the Youth
2 (MODY)
50% (1 2).

, 25 .

MODY

22%
Glucokinase
MODY 2
7q

75%

61%
HNF1

MODY 3
12q

4%
HNF4
MODY 1
20q

2%
HNF1
MODY 5
17q

<1%
IPF1

11%
MODY x
<1%
NeuroD1

MODY 6
MODY 4
2q
13q
Ellard et al

Diabetes 2001

MODY 1 - MODY 2
MODY 1 HNF4
20q
MODY 2
(glucokinase )
7 2 ,
,

MODY 3
MODY 3 HNF1
12q
,
1.


.

SU,
.
DPP4
GLP1

 MODY ,

MODY 4
-1

(IPF -1) 13q.

MODY 5
HNF1 17q
,

,
MODY 6 NEUROD1
2q

MODY

the development and validation of a clinical prediction model to determine the

probability of mody in patients with young-onset diabetes.
shields bm, mcdonald tj, ellard s, campbell mj, hyde c, hattersley at.

source
peninsula nihr clinical research facility, peninsula medical school, university of exeter, barrack road,
exeter, ex2 5dw, uk.
diabetologia 2012 jan 5. [epub ahead of print]

For MODY, compared with type 1 diabetes, these were: lower

HbA(1c), parent with diabetes, female sex and older age at
diagnosis.
MODY was discriminated from type 2 diabetes by: lower
BMI, younger age at diagnosis, female sex, lower HbA(1c),
parent with diabetes, and not being treated with oral
hypoglycaemic agents or insulin.
Both models showed excellent discrimination (c-statistic =
0.95 and 0.98, respectively), low rates of cross-validated

misclassification (9.2% and 5.3%), and good performance on

the external test dataset (c-statistic=0.95 and 0.94).


,
(24 -28 )
.

2

1
3/
( 3 ),
2/ .

 (ADA)

At the first prenatal visit, all or only high-risk women should undergo testing of
fasting plasma glucose (FPG), hemoglobin A1c, or random plasma glucose, based on the
background frequency of abnormal glucose metabolism in the population and on local
circumstances. If this testing result indicates overt diabetes, treatment and followup should be the same as for preexisting diabetes.

If testing is not diagnostic of overt diabetes and FPG is at least 5.1

mmol/L (92 mg/dL) but less than 7.0 mmol/L (126 mg/dL), GDM should be
diagnosed.

To diagnose GDM at 24 to 28 weeks of gestation, a 2-hour, 75-g OGTT

should be performed after overnight fast on all women not previously found
to have overt diabetes or GDM during testing earlier in this pregnancy.

GDM is diagnosed if

1 or more values equals or exceeds thresholds

of FPG of 5.1 mmol/L (92 mg/dL), 1-hour plasma glucose level of

10.0 mmol/L (180 mg/dL), and/or a 2-hour plasma glucose level of
8.5 mmol/L (153 mg/dL). Normal test results are defined as all
values on OGTT less than these thresholds.

The panel concluded that insufficient studies have been done to determine
whether there is a benefit of generalized testing to diagnose and treat
GDM before the usual window of 24 to 28 weeks of gestation.

Drug -

- - .

- gluconeogensis.

- ATP
.

Naicin -
. ? = 2 9%

- .

- .

- .

.

- (Leponex)
(Zyprexa) (Risperdal) =
, ( , =
).

Cumulative prevalence of diabetes

(Late Autoimmune Diabetes of the Adults)

Type 1

100

Type 2

50

50

100

LADA
0

20

40
Age at onset (years)

60

80

A prospective national surveillance study

in Canadian Children
2

1.54%

13.7

< 10

8.0

95.0%

37.0%

Diabetes Care 33:786791, 2010

 ..
NHANES 1999-2002

0.5% ..

71% ..1 29% ..2

..

> 13.000 ..

45% ..
2

15: 2 33%

Duncan Arch. Pediatr. Adolesc. Med. 2006;160:523 Geiss Am. J. Prevent. Med. 2006;30:371 Pediatrics. 2006;118:1510-1518



,
.

(2 ,
SMBG),

(HBA1c).

HbA1c =

(FPG)

(PPG)

HbA1c
H HBA1c
2-3 ,
,
. HBA1c 8,3%
.
HbA1c
.
HbA1c,
HbA1c >7.0%.
HbA1c
HbA1c ,
IFG, IG
.

 HbA1C

2

() DCCT

(stress )

HbA1C

- HbA1c
Hb (HbS, HbC, HbF, HbE) interfer

HbA1C
turn-over

( , ,
, ) HbA1C

(1, ),
HbA1C

90-130mg% (ADA), 100mg% ()

<110mg% (IDF), 8
<130mg%
2 <180mg%
(ADA ) <145mg%(IDF).

 ()

HbA1c 7.0%
HbA1c 7.0%
( ),
130 mg/dl (2
) 180 mg/dl.
HbA1c
(7.0%) .
HbA1c
, .



.

... 2
,
,
HbA1c 6.5%,


HbA1c
,
,

.



, ,
.., HbA1c 7.0 - 7.5% C

... 3

( ,
..),
,
.
,
, .
HbA1c
,

ADA

IDF

ACE

<7.0

<6.5

<6.5

80-100

<100

<110

<180

<135

<140

HbA1c (%)

(mg/dl)
2
(mg/dl)

ADA: American Diabetes Association
IDF: International Diabetes Federation
ACE: American College of Endocrinology

,
,
( ,)
.

 . : &

...

2-4x (>400%)

2-6x (>200%)

17x (32%)

25x (14-40%)

80%

5x (50%)

: <130mm/hg
<80mm/hg
HDL : >40mg/dl, > 50mg/dl
LDL <70mg/dl
<200mg/dl
30 ,
<30%.