Treatment-related progression of subclinical atherosclerosis in latent autoimmune diabetes in adults: A two-year longitudinal study

IF 3.1 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications Pub Date : 2026-03-01 Epub Date: 2026-01-26 DOI:10.1016/j.jdiacomp.2026.109269

Yufei Xiang , Xiaohan Tang , Yang Xiao , Xia Li , Gan Huang , Qichang Zhou , Zhiguang Zhou

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Abstract

Background

Latent autoimmune diabetes in adults (LADA) exhibits clinical features overlapping type 1 and type 2 diabetes. However, the burden and longitudinal progression of subclinical atherosclerosis (AS) in LADA, particularly under different treatments, remain insufficiently defined.

Methods

This retrospective secondary analysis used data from a previously conducted clinical trial evaluating β-cell–preserving therapies in LADA. A total of 103 adults with diabetes were included (64 LADA, 39 T2DM). Carotid and femoral intima–media thickness (IMT) were assessed using high-resolution B-mode ultrasound at baseline, and 48 LADA patients underwent repeat assessment after two years. Participants received either insulin-based therapy or oral antidiabetic drugs (OADs), including sulfonylureas (SUs) and non-SU agents. Multivariable regression and mixed-effects models were used to compare baseline IMT and evaluate longitudinal IMT change.

Results

Compared with T2DM, LADA participants were younger (p = 0.002) and had higher HbA1c (p = 0.001), with similar lipid profiles. Baseline carotid IMT was lower in LADA in unadjusted analyses but was comparable after multivariable adjustment (p = 0.579). Over two years, insulin-treated LADA participants showed no significant progression of carotid or femoral IMT. In contrast, SU exposure was associated with significant carotid IMT progression (p = 0.048) and a trend toward increased femoral IMT.

Conclusions

After adjustment for confounders, subclinical atherosclerosis in LADA was comparable to that in T2DM. In longitudinal analyses within LADA, insulin-based therapy was associated with stable IMT, whereas SU exposure was associated with greater IMT progression. These findings support further prospective studies to clarify treatment-related vascular effects in LADA and to inform cardiovascular risk–focused management.

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成人潜伏性自身免疫性糖尿病亚临床动脉粥样硬化治疗相关进展：一项为期两年的纵向研究

背景：成人潜伏性自身免疫性糖尿病（LADA）的临床特征与1型和2型糖尿病重叠。然而，LADA的亚临床动脉粥样硬化（AS）的负担和纵向进展，特别是在不同的治疗下，仍然没有充分的定义。方法：本回顾性二次分析使用了先前进行的评估LADA中β细胞保存疗法的临床试验的数据。共纳入103例成人糖尿病患者（LADA 64例，T2DM 39例）。在基线时使用高分辨率b超评估颈动脉和股动脉内膜-中膜厚度（IMT）， 48例LADA患者在两年后进行重复评估。参与者接受基于胰岛素的治疗或口服降糖药（OADs），包括磺脲类药物（SUs）和非su药物。多变量回归和混合效应模型用于比较基线IMT和评估纵向IMT变化。结果：与T2DM相比，LADA参与者更年轻（p = 0.002）， HbA1c更高（p = 0.001），血脂谱相似。在未调整分析中，基线颈动脉IMT在LADA中较低，但在多变量调整后具有可比性（p = 0.579）。在两年多的时间里，胰岛素治疗的LADA参与者没有显示出颈动脉或股动脉IMT的显著进展。相反，SU暴露与颈动脉IMT进展显著相关（p = 0.048），并有增加股骨IMT的趋势。结论：调整混杂因素后，LADA患者的亚临床动脉粥样硬化与T2DM患者相当。在LADA的纵向分析中，基于胰岛素的治疗与稳定的IMT相关，而SU暴露与更大的IMT进展相关。这些发现支持进一步的前瞻性研究，以阐明LADA治疗相关的血管效应，并为心血管风险管理提供信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of diabetes and its complications 医学-内分泌学与代谢

CiteScore

5.90

自引率

3.30%

发文量

153

审稿时长

16 days

期刊介绍： Journal of Diabetes and Its Complications (JDC) is a journal for health care practitioners and researchers, that publishes original research about the pathogenesis, diagnosis and management of diabetes mellitus and its complications. JDC also publishes articles on physiological and molecular aspects of glucose homeostasis. The primary purpose of JDC is to act as a source of information usable by diabetes practitioners and researchers to increase their knowledge about mechanisms of diabetes and complications development, and promote better management of people with diabetes who are at risk for those complications. Manuscripts submitted to JDC can report any aspect of basic, translational or clinical research as well as epidemiology. Topics can range broadly from early prediabetes to late-stage complicated diabetes. Topics relevant to basic/translational reports include pancreatic islet dysfunction and insulin resistance, altered adipose tissue function in diabetes, altered neuronal control of glucose homeostasis and mechanisms of drug action. Topics relevant to diabetic complications include diabetic retinopathy, neuropathy and nephropathy; peripheral vascular disease and coronary heart disease; gastrointestinal disorders, renal failure and impotence; and hypertension and hyperlipidemia.