High diagnostic sensitivity of glutamate decarboxylase autoantibodies in insulin-dependent diabetes mellitus with clinical onset between age 20 and 40 years

Research output: Contribution to journalArticle

Abstract

Patients with adult-onset Type 1 (insulin-dependent) diabetes mellitus (IDDM) are more difficult to identify than young patients, as their clinical onset is often less acute with a questionable state of insulin dependency. Classification may be facilitated by the detection of autoantibodies that are associated with IDDM. The prevalence of islet cell autoantibodies (ICA) and insulin autoantibodies (IAA) is, however, markedly lower in adult than in young patients. The present study assesses the usefulness of antibodies against glutamate decarboxylase (GAD), as a complementary marker. Sera from 312 recent-onset IDDM patients under age 40 and 163 age-matched controls were assayed for IAA, ICA, and antibodies against recombinant GAD65 (Mr 65,000) or GAD67 (Mr 67,000). IAA or ICA occurred in over 90% of patients diagnosed under age 20 but only in 65% of patients between age 20 and 40. Determination of GAD65-Ab did not increase the percent antibody positive patients under age 10, but did so at older ages: from 92–98% in the 10–19 years age group, and from 65–85% in the 20–39 years age group. The determination of GAD67-Ab did not add to the information provided by the GAD65-Ab assay. Our results indicate that, alone or in combination with ICA, the GAD65-Ab assay identified more patients with an IDDM marker in the age group 20–39 years than in the group under age 20.

Details

Authors
  • Christina L. Vandewalle
  • Alberto Falorni
  • Sigrun Svanholm
  • Åke Lernmark
  • Daniel G. Pipeleers
  • Frans K. Gorus
External organisations
  • Vrije Universiteit Brussel (VUB)
  • Belgian Diabetes Registry
  • Karolinska University Hospital
Original languageEnglish
Pages (from-to)846-851
JournalJournal of Clinical Endocrinology and Metabolism
Volume80
Issue number3
Publication statusPublished - 1995 Jan 1
Publication categoryResearch
Peer-reviewedYes
Externally publishedYes