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[ADA2014]成人糖尿病诊断:T1DM、LADA还是T2DM?
——美国宾夕法尼亚大学Stanley Schwartz教授访谈
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作者:S.Schwartz 2014/6/19 11:06:00    加入收藏
内容概要:《国际糖尿病》:β细胞功能对于糖尿病诊断有着非常重要的价值。我们知道有很多重要的生物标记物,第一个就是谷氨酸脱羧酶,请问现在是否还有其他一些可用于糖尿病诊断的新的生物标记物?
  <International Diabetes> :Another question, in the prospect of using genetic diagnosis techniques into the diagnosis of diabetes, what is your insight of bringing that into the diagnosis of diabetes?
  Dr. Schwartz : Let me put that in context.  In the past couple of years we have been trying to find the genes for LADA (latent autoimmune diabetes of adulthood) and in trying to find enough samples to evaluate we found that we do not have enough samples stored, it is hard to develop, and people are worried about costs and so forth and so on.  The purpose of finding the genes is because if you know the genes then you can find out how they cause impact on beta cells and cause diabetes.  We can then get a pharmacogenetic therapy and pick the right drug for the right gene abnormality.  Even right now, we do not know or can specifically address which drugs will work for which gene abnormalities with exception for some MODY (maturity onset diabetes of the young) situations. I am saying we should make the investment now, every patient get genotyped, and have these in different storages whether in health systems, insurers, different commercial and non commercial laboratory places, have it and then anonymize the data so we can protect the anonymity of different patients, and then people like us doing research, other people doing research can then find out what these genes are, find out how they work, and then for the benefit of the patients, we will find out specific therapies that work for those genes.  That would be the value.
  《国际糖尿病》:对于基因诊断技术用于糖尿病的前景,请问您有何看法?
  Schwartz教授: 首先我要介绍一下这个问题的背景。在过去几年中我们一直试图寻找成人隐匿性自身免疫性糖尿病(LADA)的基因,并努力寻找足够的样本来评估我们发现的基因,但我们没有足够的样本数,又加上患者对费用的担心等等问题,导致开展相关研究有一定难度。寻找这些基因的目的是为了更好地了解其对β细胞的影响,从根源上探索糖尿病的发病机制。这样我们就可以根据不同的基因异常来选择正确的药物治疗。直到目前为止,除了年轻的成年发病型糖尿病(MODY)之外,我们还不知道哪种药物对哪种基因异常有效。
  我的建议就是应该做些调查,获得每例患者的基因型分型,并将其录入不同的数据库中,包括医疗卫生系统、保险公司、各种商业及非商业实验室,并做匿名处理以保护患者隐私,而当像我们这样需要做研究时就可以从中找到相关基因,进行科学研究,研发出针对这些基因的特殊治疗,最终造福于患者。这才是基因技术的价值所在。
 
  <International Diabetes> : I know you are going to go to China in July to attend a conference in Xiamen.
  Dr. Schwartz :Yes I think it is the Chinese Endocrine Society.
  <International Diabetes> : We would love to see you there.
  Dr. Schwartz : Please contact me,  I will be talking on insulin resistance which is absolutely critical for China.  In China they store more visceral fat at lower BMI than US and other locations.  They have to understand that they have insulin resistance even if they do not look it and then there is more kinds of insulin resistance.  If we recognize the importance then guess what even now we have therapies that we can use for treatment.
  《国际糖尿病》:我知道您今年7月会来中国西安参加一个会议
  Schwartz 教授:是的,那应该是中国内分泌学学会的会议。
  《国际糖尿病》: 我们期待再次见到您。
  Schwartz 教授:请到时候联系我。我的讲题是关于胰岛素抵抗的,这一问题对中国来说特别重要。与美国和其他地区相比,中国人BMI较低,但内脏脂肪较多。他们必须明白和面对胰岛素抵抗的问题,其中又分好几种不同的类型。如果能认识到这一重要性,自然也就知道究竟应该用怎样的治疗对患者是最有利的。


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