title: No signs of progressive beta cell damage during 20 years of prospective follow-up of autoantibody-negative diabetes.
abstract: Both type 1 and type 2 diabetes are considered to be associated with different degrees of progressive beta cell damage. However, few long-term studies have been made. Our aim was to study the clinical course of 20 years of diabetes disease, including diabetes progression, comorbidity, and mortality in a prospectively studied cohort of consecutively diagnosed diabetic patients. Among all 233 patients diagnosed with diabetes during 1985-1987 in Malmö, Sweden, 50 of 118 surviving patients were followed-up after 20 years. The age at diagnose was 42.3 ± 23.1 and 57.5 ± 13.6 years for antibody-positive and antibody-negative patients, respectively. HbA1c and plasma lipids were analyzed with regard to metabolic control. Islet antibody-negative patients at diagnosis had highly preserved C-peptide levels after 20 years in contrast to antibody-positive patients (antibody negative: C-peptide 0 years 0.78 ± 0.47 and 20 years 0.70 ± 0.46 (nmol/l), P = 0.51 and antibody positive: C-peptide 0 years 0.33 ± 0.35 and 20 years 0.10 ± 0.18; P < 0.001. Islet antibodies but not age, BMI, or C-peptide at diagnosis were predictors of C-peptide levels at 20 years when analyzed by logistic regression (P < 0.05). HbA1c did not differ between the groups after 20 years. The 20-year mortality was higher among antibody-negative patients, dependent on the higher age at diagnosis in this group (number of deaths: antibody positive: 18 of 56 vs. antibody negative: 109 of 188, P < 0.001). Of the deceased, 79% had died from diseases or complications that may be associated with diabetes. We found no progressive beta cell damage in autoantibody-negative diabetes at a 20-year follow-up of the clinical course of diabetes.
authors.affiliation: Department of Clinical Sciences/Diabetes and Endocrinology, Skåne University Hospital, Lund University, Malmö, Sweden. ella.ekholm@med.lu.se
authors.forename: E
authors.initials: E
authors.lastname: Ekholm
authors.forename: A
authors.initials: A
authors.lastname: Gottsäter
authors.forename: L B
authors.initials: LB
authors.lastname: Dahlin
authors.forename: G
authors.initials: G
authors.lastname: Sundkvist
mesh_terms: D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000032:analysis / Q000097:blood; D016923:Cell Death; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000473:pathology; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000276:immunology / Q000473:pathology*; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D050417:Insulin-Secreting Cells / Q000473:pathology*; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000473:pathology; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D001323:Autoantibodies