Slow metabolic deterioration towards diabetes in islet cell antibody positive patients with autoimmune polyendocrine disease

Wagner, R., Genovese, S., Bosi, E. , Becker, F., Bingley, P. J., Bonifacio, E., Miles, K. A., Christie, Michael, Bottazzo, G. F. and Gale, E. A. M. (1994) Slow metabolic deterioration towards diabetes in islet cell antibody positive patients with autoimmune polyendocrine disease. Diabetologia, 37 (4). pp. 365-371. ISSN 0012-186X

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We studied metabolic progression to IDDM in a cohort of adults who are ICA-positive and have associated autoimmune endocrine disease or circulating organ-specific autoantibodies (the Polyendocrine Study). Of the 186 individuals recruited 27 developed overt diabetes after a median follow-up of 4.5 years (range 0.4-12). Of these, eight patients did not require insulin treatment until at least 6 months after clinical diagnosis, with an interval of 1.8 years (1.2-5.7). An IVGTT was performed in 38 subjects and 23 had sequential studies. Of the initial 38 subjects six developed diabetes and only three showed a loss of FPIR to glucose (below the first percentile of a normal control group) before clinical onset of the disease. An additional three subjects showed a loss of the FPIR, and all still have normal glucose tolerance after median follow-up of 28 months (22-95). A "whole" or "mixed" pattern of islet cell staining was found in five of the six patients who developed diabetes and antibodies against an islet 37 k-antigen were detectable in four patients, all of whom required insulin soon after diagnosis. A beta-cell "selective" ICA staining pattern was seen in 14 of 17 subjects who did not develop diabetes and the "mixed" pattern in only three. None of this group had detectable 37k-antibodies. We conclude that metabolic deterioration is slow in polyendocrine patients, and that the IVGTT has less prognostic significance in this group than in first degree relatives of patients with IDDM. In contrast, the presence of the "whole" or "mixed" ICA staining pattern or of 37k-antibodies can identify a high risk of progression to IDDM within this polyendocrine population and may indicate the rate of metabolic deterioration. © 1994 Springer-Verlag.

Keywords:pancreas islet cell antibody, adult, article, autoimmunity, clinical article, diabetes mellitus, female, glucose tolerance test, human, male, polyendocrinopathy, priority journal, Adolescent, Adult, Aged, Autoantibodies, Blood Glucose, Diabetes Mellitus, Insulin-Dependent, Fluorescent Antibody Technique, Glutamate Decarboxylase, Insulin Antibodies, Islets of Langerhans, Middle Age, Polyendocrinopathies, Autoimmune, Support, Non-U.S. Gov't
Subjects:A Medicine and Dentistry > A100 Pre-clinical Medicine
Divisions:College of Science > School of Life Sciences
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ID Code:18160
Deposited On:31 Jul 2015 11:11

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