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The Melbourne Pre‐Diabetes Study: prediction of type 1 diabetes mellitus using antibody and metabolic testing
- Source :
- Medical Journal of Australia. 169:81-84
- Publication Year :
- 1998
- Publisher :
- AMPCo, 1998.
-
Abstract
- OBJECTIVES: To determine the utility of various autoantibodies in predicting progression to clinical diabetes in first-degree relatives of patients with type 1 diabetes mellitus. PARTICIPANTS: 3315 first-degree relatives of patients with type 1 diabetes (1161 parents, 1206 siblings and 948 offspring) recruited through diabetes clinics, private endocrinologists, Diabetes Australia and the Juvenile Diabetes Foundation. MAIN OUTCOME MEASURES: Prevalence of islet cell antibodies (ICA) levels > or = 20 JDFu, insulin autoantibodies (IAA) levels > 100 nU/mL, and antibodies to glutamic acid decarboxylase (GADAb) and tyrosine phosphatase IA2 (IA2Ab); change in beta cell function over time; and development of clinical diabetes. RESULTS: 2.6% of relatives had elevated ICA levels, 1.3% had elevated IAA levels and 0.3% had both. High ICA levels were significantly more frequent in siblings than in offspring or parents, and were more frequent in relatives younger than 20 years. GADAb were detected in 68% and IA2Ab in 57% of relatives with elevated ICA and/or IAA levels. Diabetes developed in 33 relatives (25 siblings, 2 offspring and 6 parents). Before diagnosis of clinical diabetes, high ICA levels were detected in 18 (58%), high IAA levels in 7 (23%), both in 5 (15%), and either in 19 (61%); GADAb were detected in 26 (84%), IA2Ab in 13 (42%), both in 11 (35%), and either in 28 (90%). First phase insulin release (FPIR) less than 50 mU/L was very strongly associated with progression to diabetes. In relatives with FPIR initially greater than 50 mU/L who eventually developed diabetes, there was a gradual and continuous reduction in FPIR over time before diagnosis. CONCLUSIONS: Type 1 diabetes can be diagnosed in the preclinical stage. The recently described antibodies to glutamic acid decarboxylase and tyrosine phosphatase IA2 appear superior to ICA as screening tools for the preclinical diagnosis of type 1 diabetes.
- Subjects :
- Adult
medicine.medical_specialty
Offspring
medicine.medical_treatment
Glutamate decarboxylase
Fluorescent Antibody Technique
Autoantigens
Gastroenterology
Prediabetic State
Islets of Langerhans
Predictive Value of Tests
Immunopathology
Internal medicine
Diabetes mellitus
Insulin Secretion
medicine
Humans
Insulin
Receptor-Like Protein Tyrosine Phosphatases, Class 8
Pancreas
Autoantibodies
Protein Tyrosine Phosphatase, Non-Receptor Type 1
Type 1 diabetes
Glutamate Decarboxylase
business.industry
Receptor-Like Protein Tyrosine Phosphatases, Class 2
Autoantibody
Membrane Proteins
General Medicine
medicine.disease
Diabetes Mellitus, Type 1
Endocrinology
ROC Curve
Predictive value of tests
Disease Progression
Protein Tyrosine Phosphatases
business
Biomarkers
Follow-Up Studies
Subjects
Details
- ISSN :
- 13265377 and 0025729X
- Volume :
- 169
- Database :
- OpenAIRE
- Journal :
- Medical Journal of Australia
- Accession number :
- edsair.doi.dedup.....e47b2a5a275ad4bd80d38d1e20365ddf