Clinical and pathogenic significance of pancreatic-islet-cell antibodies in diabetics treated with oral hypoglycaemic agents.
20 out of 179 diabetics treated with oral hypoglycaemic agents (O.H.A.) within 3 mo of diagnosis had pancreatic-islet-cell antibodies (ICAb) in their sera at diagnosis or later. 13 of these 20, compared with only 14 of the remaining 159, subsequently required insulin at a mean follow-up of 2 yr 10 mo and 4 yr 11 mo, respectively (p less than 10(-7)). 5 of the 7 ICAb-positive diabetics still continuing on O.H.A. therapy after a mean follow-up of 4 yr 6 mo required maximum or near-maximum combined oral therapy, while only 34 of the 145 ICAb-negative diabetics continuing on O.H.A. did so at a mean follow-up of 5 yr 4 mo (p less than 0.02). In addition, 81 diabetics treated initially with diet for a mean time of 4 yr 7 mo before going on to O.H.A. therapy were studied. All were ICAb-negative when tested at a mean interval of 6 yr 10 mo from diagnosis. By the end of the mean follow-up period of 10 yr 3 mo, 27 were on combined oral therapy and 3 had been transferred to insulin treatment. ICAb-positive diabetics on O.H.A. had a high prevalence of a personal history of organ-specific autoimmune disease, thyrogastric antibodies, a family history of insulin-dependent diabetes and possibly of HLA-B8 comparable to that in insulin-dependent diabetes and higher than that expected in a control population or in diabetics controlled by diet alone. We believe that ICAb-positive diabetes controlled by O.H.A. is an earlier stage in the same disease process (type-I diabetes) that culminates in insulin-dependency.
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000302:isolation & purification*; D001327:Autoimmune Diseases / Q000276:immunology*; D001645:Biguanides / Q000008:administration & dosage / Q000627:therapeutic use; D001835:Body Weight; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000276:immunology*; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000627:therapeutic use; D007515:Islets of Langerhans / Q000276:immunology*; D008875:Middle Aged; D013453:Sulfonylurea Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors
D001323:Autoantibodies; D001645:Biguanides; D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds