R Perchard1, D MacDonald2, J Say3, J Pitts4, S Pye2, J Allgrove3, K Banerjee4, R Amin5. 1. Department of Paediatrics, Royal London Hospital, London, UK Department of Paediatrics, Queens Hospital, Romford, UK. 2. Department of Immunology, Royal London Hospital, London, UK. 3. Department of Paediatrics, Royal London Hospital, London, UK. 4. Department of Paediatrics, Queens Hospital, Romford, UK. 5. Clinical & Molecular Genetics Unit, UCL Institute of Child Health, London, UK.
Abstract
OBJECTIVE: We prospectively determined islet autoantibody status in children presenting with diabetes to a single UK region in relation to ethnicity. DESIGN: 316 (68.0% non-white) children presenting with diabetes between 2006 and 2013 were tested centrally for islet cell autoantibodies (ICA) and glutamic acid decarboxylase autoantibodies (GAD-65) at diagnosis, and if negative for both, tested for insulin autoantibodies (IAA). The assay used to measure GAD-65 autoantibodies changed from an in-house to a standardised ELISA method during the study. RESULTS: Even with use of the standardised ELISA method, 25.8% of children assigned a diagnosis of type 1 diabetes still tested negative for all three autoantibodies. 30% of children assigned a diagnosis of type 2 diabetes were autoantibody positive, and these had the highest glycated haemoglobin (HbA1c) levels at 12 months follow-up compared with other groups (p value for analysis of variance <0.001), although the sample size was small. Autoantibody positivity was similar between non-white and white children regardless of assay used (60.0% (n=129) vs 56.4% (n=57), χ(2)=0.9, p=0.35), as was mean GAD-65 autoantibody levels, but fewer non-white children had two or more autoantibodies detectable (13% (n=28) vs 27.7% (n=28), χ(2)=12.1, p=0.001). CONCLUSIONS: Islet autoantibody positivity was associated with a more severe phenotype, as demonstrated by poorer glycaemic control, regardless of assigned diabetes subtype. Positivity did not differ by ethnic group. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
OBJECTIVE: We prospectively determined islet autoantibody status in children presenting with diabetes to a single UK region in relation to ethnicity. DESIGN: 316 (68.0% non-white) children presenting with diabetes between 2006 and 2013 were tested centrally for islet cell autoantibodies (ICA) and glutamic acid decarboxylase autoantibodies (GAD-65) at diagnosis, and if negative for both, tested for insulin autoantibodies (IAA). The assay used to measure GAD-65 autoantibodies changed from an in-house to a standardised ELISA method during the study. RESULTS: Even with use of the standardised ELISA method, 25.8% of children assigned a diagnosis of type 1 diabetes still tested negative for all three autoantibodies. 30% of children assigned a diagnosis of type 2 diabetes were autoantibody positive, and these had the highest glycated haemoglobin (HbA1c) levels at 12 months follow-up compared with other groups (p value for analysis of variance <0.001), although the sample size was small. Autoantibody positivity was similar between non-white and white children regardless of assay used (60.0% (n=129) vs 56.4% (n=57), χ(2)=0.9, p=0.35), as was mean GAD-65 autoantibody levels, but fewer non-white children had two or more autoantibodies detectable (13% (n=28) vs 27.7% (n=28), χ(2)=12.1, p=0.001). CONCLUSIONS: Islet autoantibody positivity was associated with a more severe phenotype, as demonstrated by poorer glycaemic control, regardless of assigned diabetes subtype. Positivity did not differ by ethnic group. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Authors: Vassiliki Bravis; Akaal Kaur; Helen C Walkey; Ian F Godsland; Shivani Misra; Polly J Bingley; Alistair J K Williams; David B Dunger; Colin M Dayan; Mark Peakman; Nick S Oliver; Desmond G Johnston Journal: BMJ Open Date: 2018-04-04 Impact factor: 2.692
Authors: Felipe de Jesus Cortez; David Gebhart; Peter V Robinson; David Seftel; Narges Pourmandi; Jordan Owyoung; Carolyn R Bertozzi; Darrell M Wilson; David M Maahs; Bruce A Buckingham; John R Mills; Matthew M Roforth; Sean J Pittock; Andrew McKeon; Kara Page; Wendy A Wolf; Srinath Sanda; Cate Speake; Carla J Greenbaum; Cheng-Ting Tsai Journal: PLoS One Date: 2020-11-13 Impact factor: 3.240