Prediction of the course of pre-type I diabetes.
To increase knowledge on the predictability of the onset of insulin-dependent diabetes mellitus (IDDM; type I), we followed 38 subjects less than 18 years of age who had positive results on two or more islet-cell antibody tests and one identical twin who had positive results on one islet-cell antibody test. All 39 patients had longitudinal intravenous glucose tolerance tests to determine the first-phase insulin response (FPIR). Insulin dependence has developed in 10 untreated subjects less than 18 years of age. Of the 10 subjects, insulin dependence developed in eight a mean of 4.6 months after their FPIR fell to less than 30 microU/ml and a mean of 14 months after it fell to less than 46 microU/ml. Nine of the untreated subjects had an FPIR less than 67 microU/ml on at least two occasions and became insulin dependent a mean of 19 months after the value first fell below this level (95% confidence limit = 66.4% to 100%). All but one of the 10 subjects in whom IDDM developed initially had islet-cell antibody levels of greater than 80 JDF units. Insulin autoantibody values at onset were available for 9 of the 10 subjects and were positive (greater than 39 nU/ml) in six. We conclude that the combination of positive results on two islet-cell antibody tests and two diminished FPIRs (less than 67 microU/ml) in subjects less than 18 years of age reliably predicts the onset of IDDM. These data should permit intervention studies to be planned.
Chase
H P
HP
Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Denver 80262.
Garg
S K
SK
Butler-Simon
N
N
Klingensmith
G
G
Norris
L
L
Ruskey
C T
CT
O'Brien
D
D
D000293:Adolescent; D000906:Antibodies / Q000032:analysis; D001323:Autoantibodies / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000276:immunology; D005260:Female; D006801:Humans; D007328:Insulin / Q000276:immunology / Q000378:metabolism; D007515:Islets of Langerhans / Q000276:immunology; D015993:Life Tables; D008297:Male; D011236:Prediabetic State / Q000175:diagnosis* / Q000276:immunology
D000906:Antibodies; D001323:Autoantibodies; D007328:Insulin