Ketoacidosis in young adults is not related to the islet antibodies at the diagnosis of Type 1 diabetes mellitus--a nationwide study.
OBJECTIVE
To test the hypothesis that there is lower prevalence of islet antibodies in subjects with newly diagnosed Type 1 diabetes mellitus in young adulthood than in children is associated with less severe diabetes at time of diagnosis.


METHODS
This investigation was based on a nationwide study (Diabetes Incidence Study in Sweden) of 15-34-year-old newly diagnosed diabetic subjects. During 1992-1993, all diabetic subjects (excluding secondary and gestational diabetes) were reported on standardized forms, with information about clinical characteristics at diagnosis. The study examined islet cell antibodies (ICA) by indirect immunofluorescence, and autoantibodies to glutamic acid decarboxylase (GADA), tyrosine phosphatase-like antigen (IA-2A) and insulin (IAA) as well as C-peptide by radioimmunoassay.


RESULTS
Blood samples were available from 78 patients with diabetic ketoacidosis (DKA) and 517 non-acidotic patients. The prevalence of ICA (63% vs. 57%), GADA (63% vs. 66%), IA-2A (35% vs. 44%) and IAA (20% vs. 15%) were very similar in patients with or without DKA. The median levels of the four autoantibodies did not differ between the two groups. High blood glucose (P < 0.001) and low C-peptide levels (P < 0.001) were the only parameters found to be related to DKA.


CONCLUSIONS
The similarities in findings of newly diagnosed diabetic patients with or without DKA regarding ICA, GADA, IA-2A and IAA suggest that there is no relationship between the expression of antigenicity and the severity of beta-cell dysfunction. The lower prevalence of the four autoantibodies in 15-34-year-old diabetic subjects compared with previous findings in children is not explained by misclassification of diabetes type.
Ostman
J
J
Center of Metabolism & Endocrinology, Huddinge Hospital, Karolinska Institute, Stockholm, Sweden. jan.j.c.oestman@solna.mail.telia.com
Landin-Olsson
M
M
Törn
C
C
Palmer
J
J
Lernmark
A
A
Arnqvist
H
H
Björk
E
E
Bolinder
J
J
Blohmé
G
G
Eriksson
J
J
Littorin
B
B
Nyström
L
L
Scherstén
B
B
Sundkvist
G
G
Wibell
L
L
D000293:Adolescent; D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D001786:Blood Glucose / Q000032:analysis; D002096:C-Peptide / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology / Q000276:immunology*; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D005968:Glutamate Decarboxylase / Q000276:immunology; D006801:Humans; D015994:Incidence; D007330:Insulin Antibodies / Q000097:blood; D007515:Islets of Langerhans / Q000276:immunology; D008297:Male; D054562:Protein Tyrosine Phosphatase, Non-Receptor Type 1; D017027:Protein Tyrosine Phosphatases / Q000276:immunology; D054630:Receptor-Like Protein Tyrosine Phosphatases, Class 4; D011956:Receptors, Cell Surface; D013548:Sweden / Q000453:epidemiology
D001323:Autoantibodies; D001786:Blood Glucose; D002096:C-Peptide; D007330:Insulin Antibodies; D011956:Receptors, Cell Surface; C024211:islet cell antibody; C516841:PTPRA protein, human; D054562:Protein Tyrosine Phosphatase, Non-Receptor Type 1; D017027:Protein Tyrosine Phosphatases; D054630:Receptor-Like Protein Tyrosine Phosphatases, Class 4; D005968:Glutamate Decarboxylase