The relationship between islet autoantibody status and the clinical characteristics of children and adults with incident type 1 diabetes in a UK cohort
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Objectives
:
To
describe
the
characteristics
of
children
and
adults
with
incident
type
1
diabetes
in
contemporary,
multi
-
ethnic
UK,
focusing
on
differences
between
the
islet
autoantibody
negative
and
positive.
Design
:
Observational
cohort
study.
Setting:
14
6
mainly
secondary
care
centres
across
England
and
Wales.
Participants
:
3,312
people
aged
≥
5
years
were
recruited
within
6
months
of
a
clinical
diagnosis
of
type
1
diabetes
via
the
National
Institute
for
Health
Research
Clinical
Research
Network.
3,021
wer
e
of
white
European
ethnicity
and
291
(9%)
were
non
-
white.
There
was
a
small
male
predominance
(57%).
Young
people
<17
years
comprised
59%.
Main
outcome
measures
:
Autoantibody
status
and
characteristics
at
presentation.
Results
:
The
majority
presented
with
classical
osmotic
symptoms,
weight
loss,
and
fatigue.
Ketoacidosis
was
common
(42%),
especially
in
adults,
and
irrespective
of
ethnicity.
35%
were
overweight
or
obese.
Of
the
1,778
participants
who
donated
a
blood
sample,
85%
were
positive
for
one
or
more
autoantibodies
against
glutamate
decarboxylase,
islet
antigen
-
2,
and
zinc
transporter
8.
Presenting
symptoms
were
similar
in
the
autoantibody
positive
and
negative
partic
ipants,
as
was
the
frequency
of
ketoacidosis
(43%
vs
40%,
p=0·3).
Autoantibody
positivity
was
less
common
with
increasing
age
(p=0·0001),
in
males
compared
with
females
(82%
vs
90%,
p<0·0001)
and
in
people
of
non
-
white
compared
with
white
ethnicity
(73%
vs
86%,
p<0·0001).
Body
mass
index
was
higher
in
autoantibody
negative
than
positive
adults
(median,
IQR
25·5,
23·1
-
29·2
vs
23·9,
21·4
-
26·7
kg/m
2
;
p=
0·0001
)
.
A
utoantibody
negative
participants were
more
likely
to
have
a
parent
with
diabetes
(28
%
vs
16%,
p<0·
0001)
and
less
likely
to
have
another
autoimmune
disease
(4%
vs
8%,
p=
0.01).
Conclusions
:
Most
people
assigned
a
diagnosis
of
type
1
diabetes
presented
with
classical
clinical
features
and
islet
autoantibodies.
Although
indistinguishable
at
an
individual
level,
autoantibody
negative
participants
as
a
group
demonstrated
features
more
typically
associated
with
other
diabetes
subtypes.
:
To
describe
the
characteristics
of
children
and
adults
with
incident
type
1
diabetes
in
contemporary,
multi
-
ethnic
UK,
focusing
on
differences
between
the
islet
autoantibody
negative
and
positive.
Design
:
Observational
cohort
study.
Setting:
14
6
mainly
secondary
care
centres
across
England
and
Wales.
Participants
:
3,312
people
aged
≥
5
years
were
recruited
within
6
months
of
a
clinical
diagnosis
of
type
1
diabetes
via
the
National
Institute
for
Health
Research
Clinical
Research
Network.
3,021
wer
e
of
white
European
ethnicity
and
291
(9%)
were
non
-
white.
There
was
a
small
male
predominance
(57%).
Young
people
<17
years
comprised
59%.
Main
outcome
measures
:
Autoantibody
status
and
characteristics
at
presentation.
Results
:
The
majority
presented
with
classical
osmotic
symptoms,
weight
loss,
and
fatigue.
Ketoacidosis
was
common
(42%),
especially
in
adults,
and
irrespective
of
ethnicity.
35%
were
overweight
or
obese.
Of
the
1,778
participants
who
donated
a
blood
sample,
85%
were
positive
for
one
or
more
autoantibodies
against
glutamate
decarboxylase,
islet
antigen
-
2,
and
zinc
transporter
8.
Presenting
symptoms
were
similar
in
the
autoantibody
positive
and
negative
partic
ipants,
as
was
the
frequency
of
ketoacidosis
(43%
vs
40%,
p=0·3).
Autoantibody
positivity
was
less
common
with
increasing
age
(p=0·0001),
in
males
compared
with
females
(82%
vs
90%,
p<0·0001)
and
in
people
of
non
-
white
compared
with
white
ethnicity
(73%
vs
86%,
p<0·0001).
Body
mass
index
was
higher
in
autoantibody
negative
than
positive
adults
(median,
IQR
25·5,
23·1
-
29·2
vs
23·9,
21·4
-
26·7
kg/m
2
;
p=
0·0001
)
.
A
utoantibody
negative
participants were
more
likely
to
have
a
parent
with
diabetes
(28
%
vs
16%,
p<0·
0001)
and
less
likely
to
have
another
autoimmune
disease
(4%
vs
8%,
p=
0.01).
Conclusions
:
Most
people
assigned
a
diagnosis
of
type
1
diabetes
presented
with
classical
clinical
features
and
islet
autoantibodies.
Although
indistinguishable
at
an
individual
level,
autoantibody
negative
participants
as
a
group
demonstrated
features
more
typically
associated
with
other
diabetes
subtypes.
Date Issued
2018-04-04
Date Acceptance
2018-03-01
Citation
BMJ Open, 2018, 8
ISSN
2044-6055
Publisher
BMJ Journals
Journal / Book Title
BMJ Open
Volume
8
Copyright Statement
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Sponsor
Diabetes UK
Grant Number
15/0005234
Subjects
epidemiology
general diabetes
immunology
paediatric endocrinology
ADDRESS-2 Management Committee, Patient Advocate Group and Investigators
Publication Status
Published
Article Number
e020904