Islet-cell antibodies: markers of a more severe insulin-dependent diabetes mellitus?
The aim of the present study was to analyze if an association exists between metabolic condition, C-peptide secretion and islet-cell antibody (ICA) presence in insulin-dependent diabetes mellitus (IDDM) at the clinical onset of the disease. Two hundred and nine IDDM patients were studied at diagnosis. 89% of the subjects showed residual C-peptide secretion that correlated inversely with blood glucose and glycosylated hemoglobin at diagnosis and with insulin requirement at discharge. Islet-cell antibodies were detected in 68.6% of the patients, complement-fixing ICA in 30% and insulin autoantibodies in 17.3%. Islet-cell antibody positive patients had a lower glucagon stimulated C-peptide than ICA negative subjects (0.41 +/- 0.22 versus 0.54 +/- 0.25 nmol/l, p = 0.005). However patients with high titers of ICA expressed in JDF units (JDF greater than 20) showed similar C-peptide secretion than ICA positive patients with a low level of JDF (JDF less than 20). When acid-base condition was analyzed patients on ketoacidosis at diagnosis had significant higher insulin requirement, lower C-peptide secretion and higher prevalence of ICA compared to patients that were not ketotic at diagnosis. Our findings suggest that residual beta-cell secretion plays a role on metabolic condition at diagnosis of IDDM and that ICA may be the markers of a more severe form of IDDM.
Montaña
E
E
Endocrine Unit, Bellvitge Hospital Princeps d'Espanya, Barcelona, Spain.
Goday
A
A
Rosel
P
P
Casamitjana
R
R
Soler
J
J
Gomis
R
R
D000293:Adolescent; D001323:Autoantibodies / Q000032:analysis*; D015415:Biomarkers / Q000097:blood*; D001786:Blood Glucose / Q000032:analysis; D002096:C-Peptide / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000276:immunology* / Q000503:physiopathology; D005260:Female; D005934:Glucagon; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D011379:Prognosis
D001323:Autoantibodies; D015415:Biomarkers; D001786:Blood Glucose; D002096:C-Peptide; D005934:Glucagon; D006442:Glycated Hemoglobin; C024211:islet cell antibody