Summary
In a cross-sectional study, sera of 81 adult diabetic in-patients were tested for the presence of pancreatic islet cell antibodies (ICA), both IgG and complement-fixing. All patients had been well controlled initially with oral hypoglycaemic agents and therefore had been classified as having Type 2 (non-insulin-dependent) diabetes. However, 14 were subsequently classified as Type 1 (insulin-dependent) because they became insulin-dependent within 2 months of diagnosis. Ten of these patients (71%) were ICA-positive. Sixty-seven patients had been non-insulin-dependent for at least 1 year after diagnosis. Circulating ICA were present in 18 patients and 16 of these (89%) required insulin therapy. Secondary oral hypoglycaemic agent failure developed within a mean period of 3.7 years after diagnosis. In contrast, in the ICA-negative sub-group (n = 49) insulin treatment became necessary in 29 patients. Secondary oral hypoglycaemic agent failure of these patients had developed after a mean period of 8.4 years, which was significantly longer than in the ICA-positive patients (p< 0.01). Complement-fixing-ICA were detected only in sera with an ICA-IgG titre of at least 8, and its prevalence was similar in the sub-groups tested, i. e., the Type 1 diabetic patients and the patients with secondary oral hypoglycaemic agent failure. With HLA-DR typing, a significant excess of the DR3 antigen and heterozygous DR3/DR4 phenotypes was found in ICA-positive patients with secondary oral hypoglycaemic agent failure and in the Type 1 diabetic patients, which was comparable with the frequencies reported in juvenile-onset Type 1 diabetes. The heterozygous DR3/W6 phenotype was significantly increased in the ICA-positive patients when compared with 13 ICA-negative patients. Thus, the presence of ICA and an excess of certain HLA-DR phenotypes identify a sub-group within the adult diabetic population with secondary oral hypoglycaemic agent failure which can be regarded as a retarded form of Type 1 diabetes.
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Irvine WJ, Sawers JSA, Feek CM, Prescott RJ, Duncan LJP (1979) The value of islet cell antibody in predicting secondary failure of oral hypoglycemic agent therapy in diabetes mellitus. J Clin Lab Immunol 2:23–26
Di Mario U, Irvine WJ, Borsey DQ, Kyner JL, Weston J, Galfo C (1983) Immune abnormalities in diabetic patients not requiring insulin at diagnosis. Diabetologia 25: 392–395
Svejgaard A, Platz P, Ryder LP (1980) Insulin-dependent diabetes mellitus. Joint Report. In: Terasaki PI (ed) Histocompatibility Testing 1980. UCLA Tissue Typing Laboratory, Los Angeles, California, pp 638–656
Deschamps I, Lestradet H, Bonaitï C, Schmid M, Busson M, Benajam A, Marcelli-Barge A, Hors J (1980) HLA genotype studies in juvenile insulin-dependent diabetes. Diabetologia 19: 189–193
Wolf E, Spencer KM, Cudworth AG (1983) The genetic susceptibility to Type 1 (insulin-dependent) diabetes: analysis of the HLA-DR association. Diabetologia 24: 224–230
Bottazzo GF, Florin-Christensen A, Doniach D (1974) Islet-cell antibodies in diabetes with autoimmune polyendocrine deficiencies. Lancet 2: 1279–1283
Bottazzo GF, Dean BM, Gorsuch AN, Cudworth AG, Doniach D (1980) Complement-fixing islet-cell antibodies in Type-I diabetes: possible monitors of active beta-cell damage. Lancet 1:668–672
Kolb H, Krügener G, Gries FA, Bellmann O (1983) Islet cell autoantibodies: which method? Lancet 1: 479 (Letter)
Danilovs J, Terasaki PI, Parks MS, Ayoub G (1980) B lymphocyte isolation by thrombin-nylon wool Joint Report. In: Terasaki PI (ed) Histocompatibility Testing 1980. UCLA Tissue Typing Laboratory, Los Angeles, California, pp 287–288
Lendrum R, Walker GJ, Cudworth AG, Theophanides C, Pyke DA, Bloom A, Gamble DR (1976) Islet-cell antibodies in diabetes mellitus. Lancet 2: 1273–1276
Bruining GJ, Molenaar J, Tuk CW, Lindeman J, Bruining HA, Marner B (1984) Clinical time-course and characteristics of islet cell cytoplasmic antibodies in childhood diabetes. Diabetologia 26:24–29
Mustonen A, Knip M, Åkerblom HK (1983) An association between complement-fixing cytoplasmic islet-cell antibodies and endogenous insulin secretion in children with insulin-dependent diabetes mellitus. Diabetes 32: 743–747
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Gleichmann, H., Zörcher, B., Greulich, B. et al. Correlation of islet cell antibodies and HLA-DR phenotypes with diabetes mellitus in adults. Diabetologia 27 (Suppl 1), 90–92 (1984). https://doi.org/10.1007/BF00275656
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DOI: https://doi.org/10.1007/BF00275656