The natural history of pre-type 1 (insulin-dependent) diabetes mellitus in patients with autoimmune endocrine diseases.
An 11-year prospective study was carried out in 180 non-diabetic patients with organ-specific autoimmune diseases to evaluate islet cell antibodies in predicting Type 1 (insulin-dependent) diabetes mellitus. Islet cell antibodies were characterised according to titres, persistence, complement-fixing ability, and pattern. During follow-up, 14 of 46 patients with islet cell antibodies persistently greater than 5 Juvenile Diabetes Foundation Units (JDF-U) (30.4%), none of 23 with islet cell antibodies between 2.5 and 5 JDF-U or fluctuating, and 3 of 109 without islet cell antibodies (2.7%), developed diabetes. The cumulative risk of developing diabetes was 70%, 0%, and 4%, respectively. All the patients who developed diabetes were females. Eight progressed to insulin-dependence acutely, four showed a transient period of non-insulin-dependence, while two were still insulin-free. No difference was found in titres of islet cell antibodies for the risk of diabetes. Complement-fixing islet cell antibodies enhanced the cumulative risk for the disease in patients with conventional islet cell antibodies at low-middle (> or = 2.5-40 JDF-U), but not at high (> or = 80 JDF-U) titres. Forty-two patients with islet cell antibodies were investigated for the whole or the selective pattern. In the presence of the whole pattern the cumulative risk for diabetes rose to 100%, while with the selective pattern it declined to 34%. The whole pattern was found in 83% of patients who developed Type 1 diabetes acutely. In patients with organ-specific autoimmune diseases, the whole islet cell antibody pattern greatly enhances the prediction for diabetes.
Betterle
C
C
Istituto di Semeiotica Medica, University of Padua, Italy.
Presotto
F
F
Magrin
L
L
Pedini
B
B
Moro
L
L
Caretto
A
A
Zanchetta
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood*; D001327:Autoimmune Diseases / Q000097:blood / Q000150:complications / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006684:HLA-DR Antigens / Q000097:blood; D006801:Humans; D015994:Incidence; D007515:Islets of Langerhans / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology*; D011446:Prospective Studies
D001323:Autoantibodies; D006684:HLA-DR Antigens; C024211:islet cell antibody