Purpose: To assess the prevalence of pancreatic autoantibodies (Ab) and their impact on the course of type 2 diabetes mellitus (DM2) in adolescents.
Materials and methods: ICA, GADA, IA-2 and IAA were measured in 66 patients with DM2. Depending on the presence of autoantibodies (Ab) patients were divided into 2 groups: Ab- and Ab+. HLA-typing was carried out in 45 patients. The secretion of C-peptide in the standard carbohydrate breakfast test (50 g carbohydrates) in the debut of the disease and after 1 year was studied.
Results: Specific Ab were detected in 15.2% (ICA 9.1% and IAA 6.1% in low titer (up to 20 IU/ml); GADA and IA-2 were not detected). Patients of 2 groups (Ab−, n=56, and Ab+, n=10) did not differ significantly in age of diagnosis, sex ratio, obesity degree, frequency of acanthosis nigricans. The frequency of HLA-haplotypes of high risk DM1 in Ab+ was higher (77.8% against 36.1%, P<0.05), but the frequency of HLA-genotypes of high risk DM1 in the two groups did not differ significantly. The level of HbA1c in the debut of DM was higher in Ab+(7.4% (7.0; 10.6) against 6.75% (6.1; 7.9), P<0.05), after 1 year HbA1c did not differ (6.4% (5.9; 7.8) and 6.1% (5.7; 6.8)). Basal level of C-peptide in the disease debut did not differ significantly (2.3 ng/ml (1,8; 4,0) in Ab+ and 3.4 ng/ml (1.9; 4.4) in Ab-), the stimulated C-peptide level was higher by 120 min in Ab- (3.2 ng/ml (3.0; 8.4) vs 15.6 ng/ml (5.1; 17.2), P<0.05). After 1 year the secretion did not differ. Insulin therapy in the debut of the disease received 40% of Ab+ and 25% - of Ab-, P=0.3. Insulin therapy was not needed in any patient minimum 1 year from the diagnosis.
Conclusions: The incidence of pancreatic Ab in adolescents diagnosed with DM2 was 15.2%. In Ab+ patients in the debut of the disease, there is a lower secretion of C-peptide at a higher level of HbA1c, but after 1 year, the secretion of C-peptide increases, and HbA1c decreases to the level in patients Ab−. The presence of low titre ICA and IAA is not associated with the emergence of the need for insulin for 1 year minimum.
Keywords: Type 1 diabetes mellitus, type 2 diabetes mellitus, adolescents, autoantibody.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology