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T CELL RESPONSES TO ISLET ANTIGENS IMPROVES DETECTION OF AUTOIMMUNE DIABETES AND IDENTIFIES PATIENTS WITH MORE SEVERE BETA CELL LESION IN PHENOTYPIC TYPE 2 DIABETES.

¹Veterans Affairs Puget Sound Health Care System,Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington

Correspondence: bbrooks{at}u.washington.edu

Latent autoimmune diabetes of adults (LADA) or type1.5 diabetes is considered to be a T cell mediated autoimmune disease. However, identification of patients is based commonly on autoantibody detection. To determine if measuring T cell (T) reactivity to islet proteins compared to measuring autoantibodies (Ab) improves detection of autoimmune diabetes and how ß-cell function correlates with T reactivity compared with Ab positivity, we assessed the T cell proliferative responses and Ab responses (ICA/IAA/IA-2Ab/GAD-Ab) to islet proteins of 36 phenotypic type 2 patients. To be considered Ab+ or T+, patients were required to be positive for a minimum of two consecutive time points. ß-cell function was measured with fasting and glucagon stimulated C-peptide. Independent of T reactivity, Ab (+) and Ab (-) patients had comparable fasting and glucagon stimulated C-peptide. Independent of Ab status, T (+) patients demonstrated significantly lower glucagon stimulated (p<0.003) C-peptide compared to T (-) patients. This data suggests that measuring T cell responses to multiple islet proteins, in phenotypic type 2 diabetes patients, improves identification of patients with autoimmune diabetes and delineates those who have a more severe ß-cell lesion compared to autoantibody assessment alone.

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