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Natural History of ß-Cell Autoimmunity in Young Children with Increased Genetic Susceptibility to Type 1 Diabetes Recruited from the General Population

The Juvenile Diabetes Research Foundation Center for Type 1 Diabetes Prevention in Finland (T.K., P.K., K.S., A.K., S.K., T.S., J.I., O.S., M.K.), Department of Pediatrics, Medical School, University of Tampere (T.K., M.K.), and Tampere University Hospital, FIN-33014 Tampere; Department of Pediatrics (P.K., K.S., S.K.), University of Oulu, FIN-90014 Oulu; Departments of Pediatrics (A.K., T.S., O.S.) and Virology (J.I.), University of Turku, FIN-20520 Turku; and Hospital for Children and Adolescents (M.K.), University of Helsinki, FIN-00029 Helsinki, Finland

Address all correspondence and requests for reprints to: Mikael Knip, M.D., Hospital for Children and Adolescents, University of Helsinki, P.O. Box 281, FIN-00029 HUCH, Finland. E-mail: mikael.knip{at}hus.fi.

Abstract

The aim of this study was to evaluate the frequency and predictive value of diabetes-associated autoantibodies, such as islet cell antibodies (ICA) and autoantibodies to insulin (IAA), GAD65 (GADA), and the IA-2 molecule (IA-2A) in genetically susceptible children from the general population during the first 2 yr of life. Of 12,170 newborn infants, 1,005 with increased genetic risk of type 1 diabetes (high risk, human leukocyte antigen DQB1*02/*0302; moderate risk, DQB1*0302/x, where x = other than *02, *0301, or *0602) were monitored for ICA, IAA, GADA, and IA-2A at 3- to 6-month intervals from birth up to a minimum age of 2 yr. In addition, all 15 genetically susceptible children from the general population who had participated in regular immunological follow-up and developed clinical type 1 diabetes by the end of April 2000 were analyzed for the development of autoantibodies. Among 1,005 children, 63 (6.3%) tested positive for at least one autoantibody, 31 for ICA (3.1%), 48 for IAA (4.8%), 23 for GADA (2.3%), and 13 for IA-2A (1.3%) at least once by the age of 2 yr. Both ICA and IAA identified 95% [95% confidence interval (CI), 77.2–99.9%] of those who tested persistently positive for multiple (2) antibodies at the age of 2 yr, GADA identified 86% (CI, 65.1–97.1%), and IA-2A identified 55% (CI, 32.2–75.6%). Close to half of the antibody-positive children (29 of 63) reverted back to antibody negativity. Autoantibodies disappeared more often among those who tested positive for IAA than among those who tested positive for other autoantibodies (P 0.021). Among the 15 children who developed type 1 diabetes, the disease sensitivity of ICA was 80% (CI, 51.9–95.7%), that of IAA was 93% (CI, 68.0–99.8%), that of GADA was 60% (CI, 32.3–83.7%), and that of IA-2A was 40% (CI, 16.3–67.7%). These results suggest that IAA are characterized by high sensitivity, early appearance, and high frequency of transient antibody positivity, whereas ICA detected with a thoroughly standardized assay appear to be more specific for the screening of ß-cell autoimmunity in young children with increased genetic susceptibility to type 1 diabetes in the Finnish population, which has the highest incidence of type 1 diabetes in the world.

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