Introduction: Type 1 Diabetes Mellitus (DM1) is an autoimmune disease resulting from the destruction of pancreatic β cells. After the diagnosis, up to 80% of patients spontaneously experience partial remission (PR) for months. New biomarkers are being studied, such as the betatrophin protein (ANGPTL8) of unknown function, but which could be involved in the evolution of DM1, in this phase of RP and even used as a therapeutic target.
Methods: Observational follow-up study. Plasma was collected from 22 patients with DM1, age at the beginning of the study 9±4.5 (years ± SD), 50% women, without obesity or other autoimmune disease. Plasma levels of beta-trophin (ELISA) were analyzed at debut and after 6, 12 and 18 months of follow-up. They were compared with the levels of 14 healthy non-obese controls of similar ages and with one patient with DM1 (initial HbA1c of 13.5%, normal weight) who persisted in RP 6 years after diagnosis. This requires low doses of insulin (<0.5 UI/kg/day), has stimulated C-peptide levels of 1.3 ng/ml and a HbA1c adjusted for insulin dose (IDDAA1c) <9, which indicates RP. The antibodies (GAD/IA2/Zn) are repeatedly negative, as well as the MODY study. Typing HLA DR4/DQ8.
Results: Plasma levels of betatrophin were significantly higher in patients with DM1 in all phases studied compared to control subjects (258.4±77.2 pg/ml, mean ± SD). A biological tendency was observed, although not significant, to decrease plasma betatrophin levels at 6 and 12 months (724.1±633.9 pg/ml, 683.7±832.7 pg/ml) with respect to diagnosis (746.9±784.1 pg/ml). The patient in RP presented significantly higher levels of beta-trophin (1535 pg/ml).
Conclusions: Betatrophin levels are increased in patients with DM1 during the first 18 months after diagnosis compared to the control group, demonstrating that betatrophin is a biomarker of pediatric DM1. The high values of this hormone in a patient with persistent RP may be related to the chronification of remission. It would be important to consider the study of betatrophin levels in more advanced phases and correlate it with the degree of autoimmunity and pancreatic reserve to determine its potential as a biomarker.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology