421T2DM are usually obese, asymptomatic, or mildly symptomatic and may have
a family history of T2DM. Further, the presence of features of insulin resistance
(e.g., acanthosis nigricans, skin tags, double chin) and a good response to oral
antidiabetic drugs also support the diagnosis of T2DM.- What are the treatment strategies for patients with LADA?
LADA is defined by lack of insulin requirement at the onset of diabetes; however,
many individuals will require insulin for adequate glycemic control within few
years. Insulin therapy should be offered to patients with LADA at the onset of
disease to preserve endogenous β-cell function by providing β-cell rest and sup-
pression of insulitis through immunomodulation. Exogenous insulin therapy
results in decreased expression of β-cell autoantigens and may activate Treg cells
and inhibit autoreactive T cells, thereby delaying the ongoing immunoinflamma-
tory destruction of β-cells. Preservation of residual β-cell function helps to pre-
vent wide swings in blood glucose and decrease the risk of hypoglycemia.
Sulfonylureas are to be avoided as these drugs enhance the expression of autoan-
tigens in β-cells and hasten the immunoinflammatory process. Metformin can be
used in some patients who have features of insulin resistance, particularly in
obese individuals.- What is “fibrocalculous pancreatic diabetes”?
“Fibrocalculous pancreatic diabetes” (FCPD) is characterized by abdominal
pain, exocrine pancreatic insufficiency, diabetes mellitus (non-ketotic), and
pancreatic calcification in the absence of alcoholism and gall stone disease.
FCPD has been described almost exclusively from developing countries of
tropical world. In the current classification of diabetes, FCPD is not considered
as a separate entity and is classified under secondary diabetes (Fig. 12.5).abFig 12.5 (a) X-ray of abdomen showing pancreatic calcification and (b) CT abdomen showing
hyperdense lesions in the pancreas suggestive of pancreatic calcification in a patient with FCPD
12 Diabetes in the Young