title: [Prognostic value of humoral and metabolic markers as an evaluation of risk for developing type 1 diabetes].
abstract: Clinical symptoms of type 1 diabetes are preceded by a long period of prediabetes stage characterised by anti-islet antibodies occurrence as well as insulin and C-peptide secretion disturbances. The aim of this study was to define the prognostic value of type 1 diabetes antiislet humoral markers (ICA, anti-GAD, anti-IA2 and IAA) and to find out thresholds for insulin and C-peptide levels at which clinically overt type 1 diabetes develops. Antiislet antibodies, serum C-peptide and insulin were determined in 86 children who, considering their antiislet autoantibodies levels, were classified as prediabetics (mean value of the observation period: 50 months). 8 (9.3%) children, who after a mean time of 35 months of prediabetes stage developed clinically overt type 1 diabetes, were selected from this group. ICA were determined by indirect immunofluorescence; anti-GAD and IAA by radioimmunoprecipitation. C-peptide and insulin levels were evaluated by radioimmunologic assays (CIS Bio International, France). Kaplan-Meier life table analysis revealed pEFS=0.89 after 92 months' observation. The risk of developing diabetes within 80 months was established. For children with positive ICA the risk rate was 0.21, for ICA and anti-GAD positive individuals - 0.39, and for ICA and IA2 positive - 0.74. A significant difference in insulin and C-peptide levels was found between children who developed clinically overt type 1 diabetes and those in prediabetes stage (9.90 vs. 21.45 micro U/ml, p<0.008; 0.34 vs. 0.67 pM/ml, p<0.001 respectively). For both hormones thresholds for high risk of developing clinically overt diabetes were pointed out. Using ROC method the threshold for insulin was determined at 12.9 micro U/ml, for C-peptide at 0.45 pM/ml. Not only the presence and levels of autoantibodies but also the plasma concentrations of C-peptide and insulin are important prognostics of clinical onset of type 1 diabetes mellitus.
authors.affiliation: Klinika Chorób Dzieci Instytutu Pediatrii UM w Łodzi, Łódź, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Młynarski
authors.forename: Krystyna
authors.initials: K
authors.lastname: Wyka
authors.forename: Joanna
authors.initials: J
authors.lastname: Bodalska-ŁIpińska
authors.forename: Witalij
authors.initials: W
authors.lastname: Andrzejewski
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Zmysłowska
authors.forename: Jerzy
authors.initials: J
authors.lastname: Bodalski
mesh_terms: D000293:Adolescent; D000917:Antibody Formation / Q000502:physiology; D001323:Autoantibodies / Q000032:analysis; D015415:Biomarkers / Q000032:analysis; D002096:C-Peptide / Q000097:blood; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis*; D005260:Female; D005968:Glutamate Decarboxylase / Q000032:analysis; D006801:Humans; D007330:Insulin Antibodies / Q000032:analysis*; D008297:Male; D011236:Prediabetic State / Q000175:diagnosis* / Q000276:immunology / Q000378:metabolism*; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D002096:C-Peptide; D007330:Insulin Antibodies; D005968:Glutamate Decarboxylase