Annals of the New York Academy of Sciences
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Ann. N. Y. Acad. Sci. · Apr 2002
ReviewBeta cell rest and recovery--does it bring patients with latent autoimmune diabetes in adults to euglycemia?
Diabetes mellitus in humans is a heterogeneous disorder classified clinically into two main types. The diagnosis of type 1 versus type 2 diabetes is made phenotypically using criteria such as age at onset, abruptness of hyperglycemic symptoms, presence of ketosis, degree of obesity and the perceived need for insulin replacement. The pathogeneses of type 1 and type 2 diabetes are believed to be different. ⋯ The disease of these autoantibody-positive type 2 diabetics is often termed latent autoimmune diabetes in adults (LADA), slowly progressive type 1 diabetes, latent type 1 diabetes, and type 1.5 diabetes. This group of patients comprises approximately 10-15% of Caucasian type 2 diabetes patients. Type 1.5 diabetes patients tend to present with islet cell autoantibodies, islet-reactive T cells, higher HbA(1c) levels, lower C peptide, and a propensity toward insulin dependency compared to autoantibody-negative classic type 2 diabetes subjects.
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Ann. N. Y. Acad. Sci. · Apr 2002
Treatment-seeking behavior and compliance of diabetic patients in a rural area of south India.
India, being a rural country, has unique problems regarding the treatment compliance of diabetic patients. This community-based study was undertaken in a rural primary health center area near Chennai (Madras) in order to better understand treatment-seeking behavior, compliance patterns, and reasons for noncompliance among rural diabetics. Compliance was indirectly measured through patient interviews and drug use charts. ⋯ Noncompliance was seen in 57% of the 112 patients interviewed, and reasons were elicited. Interruption of treatment was significantly associated with lack of education. The study identified the lack of a patient-friendly, flexible health care system as the primary reason for noncompliance.
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The HLA class II molecules play a critical role in the processing and presentation of specific peptides derived from autoantigens of pancreatic beta cells or gluten for T cell scrutiny in IDDM and CD. In the present study, extended DR3-positive haplotypes associated with autoimmunity in northern Indian patients have been reported. ⋯ This association is, indeed, unique to Indian autoimmune patients, as it replaces the otherwise most commonly associated Caucasian haplotype A1-B8-DR3 (AH8.1) in this population. Further, CD patients revealed 100% association with DQB1*0201 along with DQA*0501 (97%) either in cis or trans configuration.