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Prognostic factors for the course of β cell function in autoimmune diabetes

Törn, C. LU ; Landin-Olsson, M. LU ; Lernmark, Å LU orcid ; Palmer, J. P. ; Arnqvist, H. J. ; Blohmé, G ; Lithner, F ; Littorin, B. ; Nyström, L. and Scherstén, B. , et al. (2000) In Journal of Clinical Endocrinology and Metabolism 85(12). p.4619-4623
Abstract

This study presents a 2-yr follow-up of 281 patients, aged 15-34 yr, diagnosed with diabetes between 1992 and 1993. At diagnosis, 224 (80%) patients were positive for at least one of the following autoantibodies: islet cell antibodies (ICAs), glutamic acid decarboxylase antibodies (GADAs), or tyrosine phosphatase antibodies (IA-2As); the remaining 57 (20%) patients were negative for all three autoantibodies. At diagnosis, C-peptide levels were lower (0.27; 0.16-0.40 nmol/L) in autoantibody-positive patients compared with autoantibody-negative patients (0.51; 0.28-0.78 nmol/L; P < 0.001). After 2 yr, C-peptide levels had decreased significantly in patients with autoimmune diabetes (0.20; 0.10-0.37 nmol/L; P = 0.0018), but not in... (More)

This study presents a 2-yr follow-up of 281 patients, aged 15-34 yr, diagnosed with diabetes between 1992 and 1993. At diagnosis, 224 (80%) patients were positive for at least one of the following autoantibodies: islet cell antibodies (ICAs), glutamic acid decarboxylase antibodies (GADAs), or tyrosine phosphatase antibodies (IA-2As); the remaining 57 (20%) patients were negative for all three autoantibodies. At diagnosis, C-peptide levels were lower (0.27; 0.16-0.40 nmol/L) in autoantibody-positive patients compared with autoantibody-negative patients (0.51; 0.28-0.78 nmol/L; P < 0.001). After 2 yr, C-peptide levels had decreased significantly in patients with autoimmune diabetes (0.20; 0.10-0.37 nmol/L; P = 0.0018), but not in autoantibody-negative patients. In patients with autoimmune diabetes, a low initial level of C-peptide (odds ratio, 2.6; 95% confidence interval, 1.7-4.0) and a high level of GADAs (odds ratio, 2.5; 95% confidence interval, 1.1-5.7) were risk factors for a C-peptide level below the reference level of 0.25 nmol/L 2 yr after diagnosis. Body mass index had a significant effect in the multivariate analysis only when initial C-peptide was not considered. Factors such as age, gender, levels of ICA or IA-2A or insulin autoantibodies (analyzed in a subset of 180 patients) had no effect on the decrease in β-cell function. It is concluded that the absence of pancreatic islet autoantibodies at diagnosis were highly predictive for a maintained β-cell function during the 2 yr after diagnosis, whereas high levels of GADA indicated a course of decreased β-cell function with low levels of C-peptide. In autoimmune diabetes, an initial low level of C-peptide was a strong risk factor for a decrease in β-cell function and conversely high C-peptide levels were protective. Other factors such as age, gender, body mass index, levels of ICA, IA-2A or IAA had no prognostic importance.

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publication status
published
subject
in
Journal of Clinical Endocrinology and Metabolism
volume
85
issue
12
pages
5 pages
publisher
Oxford University Press
external identifiers
  • pmid:11134117
  • scopus:17744398406
ISSN
0021-972X
DOI
10.1210/jc.85.12.4619
language
English
LU publication?
yes
id
d8aade5c-be3e-4427-9619-b836e07ce6c4
date added to LUP
2017-09-06 15:18:46
date last changed
2024-03-13 08:23:37
@article{d8aade5c-be3e-4427-9619-b836e07ce6c4,
  abstract     = {{<p>This study presents a 2-yr follow-up of 281 patients, aged 15-34 yr, diagnosed with diabetes between 1992 and 1993. At diagnosis, 224 (80%) patients were positive for at least one of the following autoantibodies: islet cell antibodies (ICAs), glutamic acid decarboxylase antibodies (GADAs), or tyrosine phosphatase antibodies (IA-2As); the remaining 57 (20%) patients were negative for all three autoantibodies. At diagnosis, C-peptide levels were lower (0.27; 0.16-0.40 nmol/L) in autoantibody-positive patients compared with autoantibody-negative patients (0.51; 0.28-0.78 nmol/L; P &lt; 0.001). After 2 yr, C-peptide levels had decreased significantly in patients with autoimmune diabetes (0.20; 0.10-0.37 nmol/L; P = 0.0018), but not in autoantibody-negative patients. In patients with autoimmune diabetes, a low initial level of C-peptide (odds ratio, 2.6; 95% confidence interval, 1.7-4.0) and a high level of GADAs (odds ratio, 2.5; 95% confidence interval, 1.1-5.7) were risk factors for a C-peptide level below the reference level of 0.25 nmol/L 2 yr after diagnosis. Body mass index had a significant effect in the multivariate analysis only when initial C-peptide was not considered. Factors such as age, gender, levels of ICA or IA-2A or insulin autoantibodies (analyzed in a subset of 180 patients) had no effect on the decrease in β-cell function. It is concluded that the absence of pancreatic islet autoantibodies at diagnosis were highly predictive for a maintained β-cell function during the 2 yr after diagnosis, whereas high levels of GADA indicated a course of decreased β-cell function with low levels of C-peptide. In autoimmune diabetes, an initial low level of C-peptide was a strong risk factor for a decrease in β-cell function and conversely high C-peptide levels were protective. Other factors such as age, gender, body mass index, levels of ICA, IA-2A or IAA had no prognostic importance.</p>}},
  author       = {{Törn, C. and Landin-Olsson, M. and Lernmark, Å and Palmer, J. P. and Arnqvist, H. J. and Blohmé, G and Lithner, F and Littorin, B. and Nyström, L. and Scherstén, B. and Sundkvist, G. and Wibell, L. and Östman, Jan}},
  issn         = {{0021-972X}},
  language     = {{eng}},
  number       = {{12}},
  pages        = {{4619--4623}},
  publisher    = {{Oxford University Press}},
  series       = {{Journal of Clinical Endocrinology and Metabolism}},
  title        = {{Prognostic factors for the course of β cell function in autoimmune diabetes}},
  url          = {{http://dx.doi.org/10.1210/jc.85.12.4619}},
  doi          = {{10.1210/jc.85.12.4619}},
  volume       = {{85}},
  year         = {{2000}},
}