Insulin autoantibodies are of less value compared with islet antibodies in the clinical diagnosis of autoimmune type 1 diabetes in children older than 3 yr of age
- 1 September 2002
- journal article
- Published by Hindawi Limited in Pediatric Diabetes
- Vol. 3 (3), 149-154
- https://doi.org/10.1034/j.1399-5448.2002.30305.x
Abstract
Background: Insulin autoantibodies (IAA), antibodies against endogenous insulin, may be detected in type 1 diabetic children before the start of insulin treatment. Objective: To relate IAA to islet antibodies (i.e., islet cell antibodies [ICA], and antibodies against two ICA‐related islet antigens, glutamic acid decarboxylase 65 [GADA] and protein tyrosine phosphatase IA‐2 [IA‐2 A]) at diagnosis, and to endogenous β‐cell function at follow‐up after diagnosis in diabetic children. Subjects: We investigated 74 children, aged 1–15 yr, at the diagnosis of diabetes and 1–10 yr later. Insulin treatment may induce antibody development against exogenous insulin. Patients with insulin treatment ≥ 1 wk (n = 5) were therefore excluded from the final analysis. Methods: Radioligand‐binding assays based on human recombinant antigen were used to measure IAA, GADA, and IA‐2 A. ICA were determined with indirect immunofluorescence. Results: IAA were detected at a significantly lower frequency (43%; p ≤ 0.001) than ICA (86%), GADA (72%), and IA‐2 A (80%). In agreement, IAA measurements only marginally increased the frequency of positive autoimmune markers at diagnosis of diabetes (from 97 to 99% positive for at least one autoantibody). Preserved β‐cell function (detectable fasting p‐C‐peptide levels) was found in only nine patients, who were older (13 ± 3 vs. 7 ± 6 yr, p = 0.002) and had fewer of the antibodies (IAA, GADA, IA‐2 A, ICA) in high titer (> median) compared with 60 patients with undetectable p‐C‐peptide levels. Conclusions: Insulin autoantibodies are of less clinical value compared with islet antibodies in the diagnosis of autoimmune type 1 diabetes in children.Keywords
This publication has 20 references indexed in Scilit:
- Exposure to exogenous insulin promotes IgG1 and the T-helper 2-associated IgG4 responses to insulin but not to other islet autoantigens.Diabetes, 2000
- Islet cell antibody frequency differs from that of glutamic acid decarboxylase antibodies/IA2 antibodies after diagnosis of diabetesActa Paediatrica, 2000
- Clinical, autoimmune, and genetic characteristics of very young children with type 1 diabetes. Childhood Diabetes in Finland (DiMe) Study Group.Diabetes Care, 1999
- Onset age-dependent variations of three islet specific autoantibodies in Japanese IDDM patientsDiabetes Research and Clinical Practice, 1998
- Associations of GAD65- and IA-2-Autoantibodies With Genetic Risk Markers in New-Onset IDDM Patients and Their Siblings. The Belgian Diabetes RegistryDiabetes Care, 1997
- An 8-year follow-up of anti-insulin antibodies in diabetic children: relation to insulin autoantibodies, HLA type, β-cell function, clinical course and type of insulin therapyActa Paediatrica, 1995
- Anti-glutamate decarboxylase and other antibodies at the onset of childhood IDDM: a population-based studyDiabetologia, 1994
- Predictive value of islet cell and insulin autoantibodies for Type 1 (insulin-dependent) diabetes mellitus in a population-based study of newly-diagnosed diabetic and matched control childrenDiabetologia, 1992
- Insulin-Dependent Diabetes Mellitus and Autoimmunity: Islet-Cell Autoantibodies, Insulin Autoantibodies, and Beta-Cell FailureNew England Journal of Medicine, 1985
- Insulin Antibodies in Insulin-Dependent Diabetics Before Insulin TreatmentScience, 1983