Successful Prospective Prediction of Type 1 Diabetes in Schoolchildren Through Multiple Defined Autoantibodies
| Autor: | Michael S. Brantley, Rachel E. Rowe, Nicola J. Leech, James M. LaGasse, David K. McCulloch, Gerald T. Nepom, Stephanie A. Monks, Jerry P. Palmer, William Hagopian |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
Advanced and Specialized Nursing
Percentile medicine.medical_specialty Type 1 diabetes education.field_of_study business.industry Endocrinology Diabetes and Metabolism Insulin medicine.medical_treatment Population medicine.disease Internal medicine Diabetes mellitus Predictive value of tests Immunology Internal Medicine Medicine Family history business education Prospective cohort study |
| Zdroj: | Diabetes Care. 25:505-511 |
| ISSN: | 1935-5548 0149-5992 |
| DOI: | 10.2337/diacare.25.3.505 |
| Popis: | OBJECTIVE—Almost 90% of type 1 diabetes appears in individuals without a close family history. We sought to evaluate the best current predictive strategy, multiple defined autoantibodies, in a long-term prospective study in the general population.RESEARCH DESIGN AND METHODS—Autoantibodies to pancreatic islets (islet cell antibodies [ICAs]) and defined autoantibodies (d-aab) to human GAD, IA2/ICA512, and insulin were tested in 4,505 Washington schoolchildren. Eight years later, 3,000 (67%) subjects were recontacted, including 97% of subjects with any test >99th percentile.RESULTS—Six subjects developed diabetes (median interval 2.8 years), all from among the 12 individuals with multiple d-aab, representing 50% positive predictive value (95% CI 25–75%) and 100% sensitivity (58–100%). Among the others, diabetes occurred in 0 of 6 with one d-aab plus ICA, 0 of 26 with ICA only, 0 of 7 with one d-aab equaling the 99th percentile and another d-aab equaling the 97.5th percentile, 0 of 86 with one d-aab, and 0 of 2,863 with no d-aab or ICA. Adjusted for verification bias, multiple d-aab were 99.9% specific (99.86–99.93%). At this age, new d-aab seldom appeared. Once present, d-aab usually persisted regardless of disease progression, although less so for insulin autoantibodies. Insulin secretion by sequential glucose tolerance testing remained normal in four multiple d-aab subjects not developing diabetes. Of children developing diabetes, five of six (83%) would be included if HLA-DQ genotyping preceded antibody testing, but HLA-DQ did not explain outcomes among high-risk subjects, even when considered along with other genetic markers.CONCLUSIONS—Multiple d-aab were established by age 14 years and prospectively identified all schoolchildren who developed type 1 diabetes within 8 years. |
| Databáze: | OpenAIRE |
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