Combined measurement of diabetes mellitus immunological markers: an assessment of its benefits in adult-onset patients.

The convenience of combining the measurement of antibodies to glutamic acid decarboxylase (GADA), protein tyrosine phosphatase (IA-2A), and autoantibodies to insulin (IAA) in diabetic patients was assessed. We analysed 71 type 1 and 115 adult-onset diabetic patients. The latter were grouped into three categories according to the time of evolution to insulin dependence. The main findings were as follows: (i) in type 1 diabetes, the combined analysis of GADA and IA-2A showed a sensitivity of 87.4% and was not appreciably improved by adding IAA; (ii) out of 31 adults who required insulin immediately or within the first two years of diagnosis, 41.9, 29.0, and 6.5% were positive for at least one, two or all three, and all three markers, respectively; GADA was the most prevalent (35.5%) and IA-2A the least represented (16.1%); (iii) 34 adult patients with slow evolution to insulin dependence showed a completely different profile: 5.9% were GADA positive and 23.5% were IAA positive and no double or triple positivity was observed as all patients were IA-2A negative; and (iv) 50 type 2 patients who had not required insulin treatment showed a low incidence of GADA (4%) as the only marker present. We conclude that a combined double-antigen test for GADA and IA-2A is a useful strategy for prospective screening of type 1 diabetes. However, in adults, the profile of individual markers discloses the course to insulin dependence. Therefore, it seems advisable to measure the markers separately, to allow a better classification of these patients, and help define their treatment.

Gasto energetico evolutivo durante a recuperacao nutricional de lactentes desnutridos graves com infeccoes associadas / Evolutional energetics expenditures during the nutrition rehabilitation of severe undernourished infants with associated infections

Determinaram-se o gasto de energia em repouso (GER) e o quociente respiratorio (QR) de 8 lactentes desnutridos e infectados, apos a admissao hospitalar (Adm) e durante a recuperacao (Rec), que durou em media 37 dias. As idades variam de 3 a 12 meses e apresentavam um deficit medio de peso para a idade superior a 35%. Utilizou-se a tecnica de calorimetria indireta, empregando-se um calorimetro de circuito fechado. As determinacoes de VO2 e VCO2 foram efetuadas por cromatografia gasosa. A atividade fisica foi avaliada pelo score de Scopes e Ahmed. Os dados pareados mostraram que o GER, calculado pelo peso real foi semelhante entre a Adm = 70,4+/-17,4kcal/kg/dia e Rec = 79,4+/-14,7 kcal/kg/dia. Quando o GER foi calculado pelo peso/altura houve diferenca significativa entre Adm = 44,5+/-7,3 kcal/kg/dia e Rec = 55,3+/-9,5 (p<0,05).O aumento da atividade fisica na Adm como na Rec proporcionou aumento semelhante (20%) e significativo (p<0,05) do GE (tanto por peso real como por peso/altura). O QR sa Adm=0,76+/-0,09 foi significativamente menor do que na Rec = 0,83+/-0,16 p<0,05).Os AA especulam que a admissao, o GER diminuido (calculado pelo peso/altura) traduz a menor massa celular ativa dos lactentes desnutridos infectados. Conclui-se que o QR e um bom parametro para avaliar a normalizacao da atividade metabolica desses desnutridos em recuperacao nutricional .