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. 2011 Jun;34(6):1397-9.
doi: 10.2337/dc10-2088. Epub 2011 May 11.

Age of islet autoantibody appearance and mean levels of insulin, but not GAD or IA-2 autoantibodies, predict age of diagnosis of type 1 diabetes: diabetes autoimmunity study in the young

Andrea K Steck  1 , Kelly Johnson, Katherine J Barriga, Dongmei Miao, Liping Yu, John C Hutton, George S Eisenbarth, Marian J Rewers
Affiliations

Age of islet autoantibody appearance and mean levels of insulin, but not GAD or IA-2 autoantibodies, predict age of diagnosis of type 1 diabetes: diabetes autoimmunity study in the young

Andrea K Steck et al. Diabetes Care. 2011 Jun.

Abstract

Objective: We evaluated predictors of progression to diabetes in children with high-risk HLA genotypes and persistent islet autoantibodies.

Research design and methods: The Diabetes Autoimmunity Study in the Young (DAISY) followed 2,542 children with autoantibodies measured to GAD, IA-2, and insulin.

Results: Persistent islet autoantibodies developed in 169 subjects, and 55 of those progressed to diabetes. Children expressing three autoantibodies showed a linear progression to diabetes with 74% cumulative incidence by the 10-year follow-up compared with 70% with two antibodies and 15% with one antibody (P < 0.0001). Both age of appearance of first autoantibody and insulin autoantibody (IAA) levels, but not GAD or IA-2 autoantibodies, were major determinants of the age of diabetes diagnosis (r = 0.79, P < 0.0001).

Conclusions: In the DAISY cohort, 89% of children who progressed to diabetes expressed two or more autoantibodies. Age of diagnosis of diabetes is strongly correlated with age of appearance of first autoantibody and IAA levels.

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Figures

Figure 1
Figure 1
A: Progression to diabetes in children positive for anti-islet autoantibodies (n = 169). There was no significant difference in the progression rate between subjects with two or three positive antibodies. B: Progression to diabetes in children with persistently positive IAA levels and fluctuating IAA levels (n = 88). IAA Pers Pos, persistently positive IAA levels; Fluctuat IAA, fluctuating IAA levels. C: Predicted age of diagnosis of diabetes (initial IAA, GAD, and IA-2 levels) (n = 38). Analysis done in all subjects who had their first antibody measurement before 1.5 years and progressed to diabetes. D: Predicted age of diagnosis of diabetes (mean IAA, GAD, and IA-2 levels) (n = 38). Analysis was done in all subjects who had their first antibody measurement before 1.5 years and progressed to diabetes.
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