Can islet cell antibodies predict IDDM in the general population?
OBJECTIVE
To evaluate the likely prognostic significance of ICAs in children with no family history of IDDM.


METHODS
We examined the prevalence of ICAs in 2925 English schoolchildren aged 9-13 yr and in 274 age-matched siblings of children with diabetes from the same region, and we compared the estimated risk of progression to diabetes within 10 yr in the two groups.


RESULTS
ICAs were present at levels > or = 4 JDF U in 2.8% of schoolchildren and 6.6% of siblings and at > or = 20 JDF U in 0.8% of schoolchildren and 2.2% of siblings. Although ICAs are only 2-3 times more prevalent in siblings than schoolchildren, the estimated cumulative risk that siblings will progress to diabetes by age 21 is 13 times greater (2.8 vs. 0.21%).


CONCLUSIONS
ICAs are unexpectedly prevalent in English schoolchildren, but only a small minority, with this evidence of immune activation directed against islet cells, will progress to diabetes. Although ICAs alone have limited predictive value in the general population, combining two or more predictive tests in series could achieve a level of prediction equivalent to that now obtained in first-degree relatives.
Bingley
P J
PJ
Department of Diabetes and Metabolism, St. Bartholomew's Hospital, London, United Kingdom.
Bonifacio
E
E
Shattock
M
M
Gillmor
H A
HA
Sawtell
P A
PA
Dunger
D B
DB
Scott
R D
RD
Bottazzo
G F
GF
Gale
E A
EA
D000293:Adolescent; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007515:Islets of Langerhans / Q000276:immunology*; D008297:Male; D016012:Poisson Distribution; D011236:Prediabetic State / Q000097:blood / Q000175:diagnosis*; D011379:Prognosis; D012307:Risk Factors
D001323:Autoantibodies; D015415:Biomarkers; C024211:islet cell antibody