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Prognostic Factors for the Course of ß Cell Function in Autoimmune Diabetes¹

Department of Medicine (C.T., M.L.-O.), University Hospital, 221 85 Lund, Sweden; Department of Medicine, R. H. Williams Laboratory (Å.L.) and Division of Endocrinology, Metabolism and Nutrition, Diabetes Endocrinology Research Center and Diabetes Care Center, DVA Puget Sound Health Care System (J.P.P.), University of Washington, Seattle, Washington; Department of Medicine and Care (H.J.A.), Linköping University, Linköping, Sweden; Department of Internal Medicine (G.B.), Stockholm Söder Hospital, Stockholm, Sweden; Department of Medicine (F.L.), Umeå University Hospital, Umeå, Sweden; Department of Community Health Sciences (B.L.), University of Malmö/Lund, Malmö, Sweden; Department of Public Health and Clinical Medicine (L.N.), University of Umeå, Umeå, Sweden; Department of Community Health Sciences Dalby/Lund (B.S.), Lund, Sweden; Department of Endocrinology (G.S.), Malmö University Hospital, Malmö, Sweden; Department of Medicine (L.W.), University Hospital, Uppsala, Sweden; and Department of Medicine (J.Ö.), Huddinge Hospital, Stockholm, Sweden

Address correspondence and requests for reprints to: Carina Törn, B 11, BMC, 221 84 Lund, Sweden. E-mail: Carina.Torn{at}med.lu.se

This study presents a 2-yr follow-up of 281 patients, aged 15–34 yr, diagnosed with diabetes between 1992 and 1993. At diagnosis, 224 (80%) patients were positive for at least one of the following autoantibodies: islet cell antibodies (ICAs), glutamic acid decarboxylase antibodies (GADAs), or tyrosine phosphatase antibodies (IA-2As); the remaining 57 (20%) patients were negative for all three autoantibodies. At diagnosis, C-peptide levels were lower (0.27; 0.16–0.40 nmol/L) in autoantibody-positive patients compared with autoantibody-negative patients (0.51; 0.28–0.78 nmol/L; P < 0.001). After 2 yr, C-peptide levels had decreased significantly in patients with autoimmune diabetes (0.20; 0.10–0.37 nmol/L; P = 0.0018), but not in autoantibody-negative patients. In patients with autoimmune diabetes, a low initial level of C-peptide (odds ratio, 2.6; 95% confidence interval, 1.7–4.0) and a high level of GADAs (odds ratio, 2.5; 95% confidence interval, 1.1–5.7) were risk factors for a C-peptide level below the reference level of 0.25 nmol/L 2 yr after diagnosis. Body mass index had a significant effect in the multivariate analysis only when initial C-peptide was not considered. Factors such as age, gender, levels of ICA or IA-2A or insulin autoantibodies (analyzed in a subset of 180 patients) had no effect on the decrease in ß-cell function.

It is concluded that the absence of pancreatic islet autoantibodies at diagnosis were highly predictive for a maintained ß-cell function during the 2 yr after diagnosis, whereas high levels of GADA indicated a course of decreased ß-cell function with low levels of C-peptide. In autoimmune diabetes, an initial low level of C-peptide was a strong risk factor for a decrease in ß-cell function and conversely high C-peptide levels were protective. Other factors such as age, gender, body mass index, levels of ICA, IA-2A or IAA had no prognostic importance.

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