Abstract
We characterised a consecutive cohort of 132 youth onset diabetic individuals (age
at onset<30 years, mean duration of disease 5.5±6.0 years) from North India, by serological
determination of the determination of the islet cell autoantibodies, GAD65 and IA2, and clinically for coexisting autoimmune thyroid disease, malnutrition and
pancreatic calcification. Five types of diabetes were delineated: Type 1 (37%), ketosis
resistant (32%), Type 2 (13%), fibrocalculous pancreatopathy (11%) and autoimmune
polyglandular syndrome (7%). C-peptide response to glucagon was assessed in a representative
subset of 50 patients with Type 1, ketosis resistant, and autoimmune polyglandular
syndrome. A total of 22.4% of Type 1 and 30% of autoimmune polyglandular syndrome
subjects showed both GAD65 plus IA-2 autoantibody positivity, significantly more than the 4.7% positivity shown
by the ketosis resistant type. However, GAD65 antibody positivity alone was seen in 38% of ketosis resistant subjects which was
significantly more than the 14.2 and 10% positivity seen in Type 1 and autoimmune
polyglandular groups, respectively. The fibrocalculous pancreatopathy group showed
GAD65 plus IA-2 autoantibody positivity in 14.2% and GAD65 autoantibody alone positivity in 7.1%. 26 and 60%, respectively, of the Type 1 and
autoimmune polyglandular syndrome groups had thyroid microsomal autoantibody positivity.
Type 1 showed significantly less C-peptide response to glucagon when compared to the
ketosis resistant and autoimmune polyglandular syndrome groups. The controls and Type
2 diabetic individuals tested negative for islet cell autoimmunity markers. These
findings demonstrate a role of islet cell autoimmunity in the pathogenesis of four
out of the five clinical types of youth onset diabetes seen in North India.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Diabetes Research and Clinical PracticeAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Observations on clinical patterns of diabetes mellitus in India.Diabetes. 1965; 14: 404-412
- Diabetes in Jamaica.Lancet. 1955; 29: 891-897
- Ketosis resistant young diabetics.Lancet. 1965; i: 1254-1255
- Diabetes mellitus with onset under 40 years in North India.J. Assoc. Phys. India. 1974; 22: 879-888
- Tropical diabetes syndromes in Northern India.Diabetes. 2000; 49: A90
- Tropical or malnutrition related diabetes: a real syndrome?.Lancet. 1986; I: 1135-1138
WHO study group, Diabetes mellitus, Tech. Rep. Ser. 727 (1985) 10–20.
Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 24 (Suppl. 1) (2001) S5–S20.
- Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation.Diabet. Med. 1998; 15: 539-553
- IA-2, a transmembrane protein of the tyrosine phosphatase family, is a major autoantigen in insulin-dependent diabetes mellitus.Proc. Natl. Acad. Sci. USA. 1996; 93: 6367-6370
- Only multiple autoantibodies to islet cells (ICA), insulin, GAD65, IA-2, and IA-2β predict immune mediated (Type-1) diabetes in relatives.J. Autoimmun. 1999; 12: 279-287
- Practical clinical value of the C-peptide response to glucagon stimulation in the choice of treatment in diabetes mellitus.Acta Med. Scand. 1981; 210: 153-156
- DELISA: sensitive nonisotopic assay for GAD autoantibodies, a key risk assessment marker for insulin-dependent diabetes mellitus.Clin. Chem. 1996; 42: 263-269
- Improved colorimetric assay for glycosylated hemoglobin.Clin. Chem. 1981; 27: 669-672
- A new method for the direct estimation of serum cholesterol.J. Lab. Clin. Med. 1953; 41: 486-492
- Simple manual procedure for determination of serum triglycerides.Clin. Chem. 1975; 21: 768-770
- Incidence of IDDM in children in urban population in southern India. Madras IDDM registry group, Madras, South India.Diabetes Res. Clin. Pract. 1996; 34: 79-82
- Differing frequency of autoantibodies to glutamic acid decarboxylase among Koreans, Thais, and Australians with diabetes mellitus.Clin. Immunol. Immunopathol. 1995; 74: 202-206
- Prevalence of glutamic acid decarboxylase antibodies amongst young Malaysian diabetics.Diabetes Res. Clin. Pract. 1999; 43: 59-66
- Combined measurements of GAD65 and ICA512 antibodies in acute onset and slowly progressive IDDM.Diabetes Res. Clin. Pract. 1997; 35: 91-98
- Pancreatic Beta cell function and antibodies to glutamic acid decarboxylase (anti-GAD) in Chinese patients with clinical diagnosis of insulin-dependent diabetes mellitus.Diabetes Res. Clin. Pract. 1996; 32: 27-34
- Islet cell autoimmunity in white and black children and adolescent with IDDM.Diabetes Care. 1998; 21: 1824-1827
- Absence of islet cell autoantibodies in Jamaican blacks with diabetes mellitus.West Indian Med. J. 1986; 35: 35-37
- Islet cell and other organ-specific antibodies in US Caucasians and blacks with insulin dependent diabetes mellitus.Diabetes. 1980; 29: 589-592
- Early development and spreading of autoantibodies to epitopes of IA-2 and their association with progression to Type 1 diabetes.J. Immunol. 1998; 161: 6963-6969
- Antibodies to pancreatic islet cell antigens in diabetes seen in Southern India with particular reference to fibrocalculous pancreatic diabetes.Diabet. Med. 1998; 15: 156-159
Article info
Publication history
Accepted:
January 30,
2001
Footnotes
☆This study was presented in part at the Annual Meeting of the American Diabetes Association, San Antonio, 9–13 June, 2000 (ref. #5).
Identification
Copyright
© 2001 Elsevier Science Ireland Ltd. Published by Elsevier Inc. All rights reserved.
