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Title
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Screening for insulinoma antigen 2 and zinc transporter 8 autoantibodies : a cost-effective and age-independent strategy to identify rapid progressors to clinical onset among relatives of type 1 diabetic patients
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Author
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Institution/Organisation
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Belgian diabet Registry
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Abstract
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| In first-degree relatives of type 1 diabetic patients, we investigated whether diabetes risk assessment solely based on insulinoma antigen 2 (IA-2) and zinc transporter 8 (ZnT8) antibody status (IA-2A, respectively, ZnT8A) is as effective as screening for three or four autoantibodies [antibodies against insulin (IAA), glutamate decarboxylase 65 kDa (GAD) glutamate decarboxylase autoantibodies (GADA) and IA-2A with or without ZnT8A] in identifying children, adolescents and adults who progress rapidly to diabetes (within 5 years). Antibodies were determined by radiobinding assays during follow-up of 6444 siblings and offspring aged 039 years at inclusion and recruited consecutively by the Belgian Diabetes Registry. We identified 394 persistently IAA(+), GADA(+), IA-2A(+) and/or ZnT8A(+) relatives (6.1%). After a median follow-up time of 52 months, 132 relatives developed type 1 diabetes. In each age category tested (0-9, 10-19 and 20-39 years) progression to diabetes was significantly quicker in the presence of IA-2A and/or ZnT8A than in their joint absence (P < 0.001). Progression rate was age-independent in IA-2A(+) and/or ZnT8A(+) relatives but decreased with age if only GADA and/or IAA were present (P = 0.008). In the age group mainly considered for immune interventions until now (1039 years), screening for IA-2A and ZnT8A alone identified 78% of the rapid progressors (versus 75% if positive for >= 2 antibodies among IAA, GADA, IA-2A and ZnT8A or versus 62% without testing for ZnT8A). Screening for IA-2A and ZnT8A alone allows identification of the majority of rapidly progressing prediabetic siblings and offspring regardless of age and is more cost-effective to select participants for intervention trials than conventional screening. |
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Language
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English
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Source (journal)
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Clinical and experimental immunology. - Oxford
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Publication
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Oxford
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2013
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ISSN
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0009-9104
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DOI
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10.1111/J.1365-2249.2012.04675.X
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Volume/pages
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171
:1
(2013)
, p. 82-90
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ISI
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000312160800011
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Full text (Publisher's DOI)
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Full text (publisher's version - intranet only)
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