Metabolism - Clinical and Experimental
Volume 47, Issue 10 , Pages 1205-1210, October 1998

Metabolic and immune parameters at clinical onset of insulin-dependent diabetes: A population-based study☆

  • Paolo Pozzilli

      Affiliations

    • Corresponding Author InformationAddress reprint requests to Paolo Pozzili, MD, Department of Diabetes and Metabolis, St Bartholomew's Hospital, 59 Bartholomew Close, London EC IA 7BE, UK.
    • Institute Clinica Medica II, University of Rome “La Sapienza,” Rome, Italy
    • Universita Campus Biomedico, Rome, Italy
    • Clinica Pediatrica, University Cattolica Sacro Core, Rome, Italy
    • Department of Diabetes and Metabolism, St Bartholomew's Hospital, London, UK
    • London School of Medicine and Dentistry, London, UK
    • ,
  • Natalia Visalli

      Affiliations

    • Institute Clinica Medica II, University of Rome “La Sapienza,” Rome, Italy
    • Universita Campus Biomedico, Rome, Italy
    • Clinica Pediatrica, University Cattolica Sacro Core, Rome, Italy
    • Department of Diabetes and Metabolism, St Bartholomew's Hospital, London, UK
    • London School of Medicine and Dentistry, London, UK
    • ,
  • Raffaella Buzzetti

      Affiliations

    • Institute Clinica Medica II, University of Rome “La Sapienza,” Rome, Italy
    • Universita Campus Biomedico, Rome, Italy
    • Clinica Pediatrica, University Cattolica Sacro Core, Rome, Italy
    • Department of Diabetes and Metabolism, St Bartholomew's Hospital, London, UK
    • London School of Medicine and Dentistry, London, UK
    • ,
  • M. Gisella Cavallo

      Affiliations

    • Institute Clinica Medica II, University of Rome “La Sapienza,” Rome, Italy
    • Universita Campus Biomedico, Rome, Italy
    • Clinica Pediatrica, University Cattolica Sacro Core, Rome, Italy
    • Department of Diabetes and Metabolism, St Bartholomew's Hospital, London, UK
    • London School of Medicine and Dentistry, London, UK
    • ,
  • Giovanni Marietti

      Affiliations

    • Institute Clinica Medica II, University of Rome “La Sapienza,” Rome, Italy
    • Universita Campus Biomedico, Rome, Italy
    • Clinica Pediatrica, University Cattolica Sacro Core, Rome, Italy
    • Department of Diabetes and Metabolism, St Bartholomew's Hospital, London, UK
    • London School of Medicine and Dentistry, London, UK
    • ,
  • Mohammed Hawa

      Affiliations

    • Institute Clinica Medica II, University of Rome “La Sapienza,” Rome, Italy
    • Universita Campus Biomedico, Rome, Italy
    • Clinica Pediatrica, University Cattolica Sacro Core, Rome, Italy
    • Department of Diabetes and Metabolism, St Bartholomew's Hospital, London, UK
    • London School of Medicine and Dentistry, London, UK
    • ,
  • R.David G. Leslie

      Affiliations

    • Institute Clinica Medica II, University of Rome “La Sapienza,” Rome, Italy
    • Universita Campus Biomedico, Rome, Italy
    • Clinica Pediatrica, University Cattolica Sacro Core, Rome, Italy
    • Department of Diabetes and Metabolism, St Bartholomew's Hospital, London, UK
    • London School of Medicine and Dentistry, London, UK
    • ,
  • IMDIAB Study Group

Received 16 October 1997; accepted 14 April 1998.

Abstract 

The age at diagnosis of insulin-dependent diabetes mellitus (type I DM) varies between childhood and adulthood. The aim of this study was to define the immunologic and metabolic characteristics of the disease according to the age at which it is diagnosed. We evaluated the residual β-cell function (basal and stimulated C-peptide) and frequency of two major islet cell—related autoantibodies, glutamic acid decarboxylase (GAD) and tyrosine phosphatase-like molecule (IA-2ic), at the onset of type I DM. A population-based study was performed with 235 consecutive cases of recent-onset (<4 weeks) type I DM (ages 5 to 45 years) diagnosed in the Lazio region of central Italy. Five age groups were considered: patients diagnosed between ages 5 and 7 years (n = 10), 7 and 10 years (n = 38), 10 and 17 years (n = 94), 17 and 20 years (n = 17), and 20 and 45 years (n = 76). Patients diagnosed before puberty had significantly reduced C-peptide secretion compared with patients diagnosed at a later age (P < .02). Glycosylated hemoglobin (HbA1c) did not differ at diagnosis between the different age groups. Patients diagnosed at puberty or after required significantly less insulin compared with younger patients (P < .04). GAD antibodies were found in 65% and IA-2ic antibodies in 59% of patients. GAD antibodies tended to be more frequent in patients diagnosed after age 17 compared with younger patients (P = .05), while IA-2ic antibodies were not age-related. These data suggest that (1) the extent of β-cell damage differs between patients diagnosed before and after puberty, the process being more destructive in children less than 7 years of age, when C-peptide levels are the lowest; and (2) residual β-cell function at diagnosis is not influenced by the presence or absence of islet cell—related antibodies. These findings have implications for trials in type I DM diagnosis aimed at protecting β cells from end-stage destruction and in attempts to prevent the disease in susceptible individuals.

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☆ Supported by grants from the University of Rome “La Sapienza” (Facoltà 60%) and the Centro Internazionale Studi Diabete.

PII: S0026-0495(98)90324-9

Metabolism - Clinical and Experimental
Volume 47, Issue 10 , Pages 1205-1210, October 1998

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