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Relationship between islet autoantibody status and the clinical characteristics of children and adults with incident type 1 diabetes in a UK cohort

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  • Vassiliki Bravis
  • Akaal Kaur
  • Helen C Walkey
  • Ian F Godsland
  • Shivani Misra
  • Polly J Bingley
  • Alistair J K Williams
  • David B Dunger
  • Colin M Dayan
  • Mark Peakman
  • Nick S Oliver
  • Desmond G Johnston
  • ADDRESS-2 Management Committee, Patient Advocate Group and Investigators
Original languageEnglish
Pages (from-to)e020904
JournalBMJ Open
Volume8
Issue number4
DOIs
DateAccepted/In press - 1 Mar 2018
DatePublished (current) - 4 Apr 2018

Abstract

OBJECTIVES: To describe the characteristics of children and adults with incident type 1 diabetes in contemporary, multiethnic UK, focusing on differences between the islet autoantibody negative and positive.

DESIGN: Observational cohort study.

SETTING: 146 mainly secondary care centres across England and Wales.

PARTICIPANTS: 3312 people aged ≥5 years were recruited within 6 months of a clinical diagnosis of type 1 diabetes via the National Institute for Health Research Clinical Research Network. 3021 were of white European ethnicity and 291 (9%) were non-white. There was a small male predominance (57%). Young people <17 years comprised 59%.

MAIN OUTCOME MEASURES: Autoantibody status and characteristics at presentation.

RESULTS: The majority presented with classical osmotic symptoms, weight loss and fatigue. Ketoacidosis was common (42%), especially in adults, and irrespective of ethnicity. 35% were overweight or obese. Of the 1778 participants who donated a blood sample, 85% were positive for one or more autoantibodies against glutamate decarboxylase, islet antigen-2 and zinc transporter 8. Presenting symptoms were similar in the autoantibody-positive and autoantibody-negative participants, as was the frequency of ketoacidosis (43%vs40%, P=0.3). Autoantibody positivity was less common with increasing age (P=0.0001), in males compared with females (82%vs90%, P<0.0001) and in people of non-white compared with white ethnicity (73%vs86%, P<0.0001). Body mass index was higher in autoantibody-negative adults than autoantibody-positive adults (median, IQR 25.5, 23.1-29.2vs23.9, 21.4-26.7 kg/m2; P=0.0001). Autoantibody-negative participants were more likely to have a parent with diabetes (28%vs16%, P<0.0001) and less likely to have another autoimmune disease (4%vs8%, P=0.01).

CONCLUSIONS: Most people assigned a diagnosis of type 1 diabetes presented with classical clinical features and islet autoantibodies. Although indistinguishable at an individual level, autoantibody-negative participants as a group demonstrated features more typically associated with other diabetes subtypes.

TRIAL REGISTRATION NUMBER: ISRCTN66496918; Pre-results.

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