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Diabetes 51:1754-1762, 2002
© 2002 by the American Diabetes Association, Inc.
A 12-Year Prospective Study of the Relationship Between Islet Antibodies and ß-Cell Function At and After the Diagnosis in Patients With Adult-Onset Diabetes
1 Department of Endocrinology, Lund University, Malmö University Hospital, Malmö, Sweden
2 Department of Vascular Diseases, Lund University, Malmö University Hospital, Malmö, Sweden
3 Department of Clinical Chemistry, Lund University, Malmö University Hospital, Malmö, Sweden
To clarify the relationships between islet antibodies (islet cell antibody [ICA], GAD antibody [GADA], and IA-2 antibody [IA-2A]) versus the progression of ß-cell dysfunction, we have followed a group of diabetic patients from their diagnosis at 21–73 years of age. Patients with ICA had high levels of GADA and/or IA-2A at diagnosis and a more severe ß-cell dysfunction 5 years after diagnosis than those with only GADA in low concentrations. The aim of the current 12-year follow-up study was to examine the further progression of ß-cell dysfunction in relation to islet antibodies at and after diagnosis. Among 107 patients, complete ß-cell failure 12 years after diagnosis was restricted to those with islet antibodies at diagnosis (16 of 21 [77%] with multiple antibodies and 4 of 5 [80%] with only GADA). In contrast, among antibody-negative patients, fasting P-C-peptide levels were unchanged. Most GADA-positive patients (22 of 27 [81%]) remained GADA positive after 12 years. Associated with decreasing fasting P-C-peptide levels (0.85 nmol/l [0.84] at diagnosis vs. 0.51 nmol/l [0.21] 12 years after diagnosis, P < 0.05), ICA developed after diagnosis in 6 of 105 originally antibody negative mostly overweight patients. In conclusion, multiple islet antibodies or GADA alone at diagnosis of diabetes predict future complete ß-cell failure. After diagnosis, GADA persisted in most patients, whereas ICA development in patients who were antibody negative at diagnosis indicated decreasing ß-cell function.
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