[Latent autoimmune diabetes in Tunisian adults [LADA]: identification of autoimmune markers]

LADA or type 1.5 diabetes is a slowly progressive form of autoimmune diabetes of adults. The aim of this study is to evaluate the frequency of autoimmmune markers and to identify patients with LADA among diabetics diagnosed initially as having type 2 diabetes. Our study concerned 100 diabetics, aged between 31 and 77 years [age at onset > 30 years], with short term diabetes [duration < 6 years] and who required insulin therapy after 6 months from diagnosis of diabetes. All patients were screened for antibodies to Glutamic Acid Decarboxylase [GAD65], the Tyrosine Phosphatase [IA2] and Islet Cell antibodies [ICA]. Mean age of patients is 53 +/- 10.5 years. Mean age at onset of diabetes was 43.3 +/- 10 years. Insulin treatment required after 3.1 +/- 1.8 years. Positivity of at least one of the auto-antibodies was found in 78% of patients. ICA were detected in 48.5% of cases. IA2 and GAD antibodies were positive respectively in 42% and 18% of tested patients. There was no significant difference of gender. Anti-GAD positive patients had statistically significant higher initial fasting blood glucose and HDL-cholesterol serum [p = 0.01 and 0.007] than those with anti-GAD negative. Patients with anti-lA2 were characterized by more important frequency of autoimmune diseases and low rate of triglycerides. The frequency of macrovascular complications was lower in ICA positive diabetics than those with ICA negative. Patients initially diagnosed as type 2 diabetes may in many cases suffer from LADA. Auto-antibodies screening may be of interest to identify LADA at the earliest stage. Frequency of type I diabetes in adults is underestimated. The identification of LADA may help to classify diabetes and to indicate the moment of insulinotherapy

Microvascular complications in the type 2 diabetes: impact of the insulin therapy

When oral antidiabetics at optimal dosage have failed to maintain good diabetic control, insulin treatment has to be considered. The aim of this retrospective study is to evaluate over a 5 years period the incidence of progression in microvascular complications in 35 type 2 diabetes patients treated with insulin and compared to 35 controls treated with oral hypoglycemic agents. By 3-5 years, the "insulin" group had lower risks of progression in both complications: retinopathy [p=0,005] and neuropathy [p<0,05]. However, the incidence of progression in nephropathy was quite similar between the two groups. Our study confirms the long term results found in the literature about effects of insulin therapy on microvascular complications in diabetic patients

[The diabetic diet of Tunisia: lived and recommendations]

Diet is essential for diabetes treatment. It must provide a balanced nutritional intake with adaptation to each patient. The aim of this study is to evaluate the spontaneous food consumption in a group of 150 type 2 diabetic Tunisian patients. Main food consumption abnormalities are an excessive caloric intake, an excess in glucid consumption, a saturated, fatty acids intake accounting for 26 +/- 6% of the lipid ration which is positively correlated with high LDL cholesterol levels [p=0,04], a ratio animal/vegetable proteins greater than I and an insufficiency in anti-oxidant vitamins. Thus, the qualitative analysis of the, food intake shows several anomalies which exposes our diabetic patients to a high cardiovascular risk; adapted recommendations appear to be necessary