Clinical and pathogenic significance of pancreatic-islet-cell antibodies in diabetics treated with oral hypoglycaemic agents
Irvine, W.J.; McCallum, C.J.; Gray, R.S.; Duncan, L.J.
Lancet 1(8020): 1025-1027
1977
ISSN/ISBN: 0140-6736 PMID: 67485 Document Number: 119442
Of 179 diabetics treated with oral hypoglycemic agents (OHA) within 3 mo. of diagnosis, 20 had pancreatic-islet-cell antibodies (ICAb) in their sera at diagnosis or later. Thirteen of these 20, compared with only 14 of the remaining 159, subsequently required insulin at a mean follow-up of 2 yr 10 mo. and 4 yr 11 mo. respectively (P < 10-7). Five of the 7 ICAb-positive diabetics still continuing on OHA therapy after a mean follow-up of 4 yr 6 mo. required maximum or near-maximum combined oral therapy, while only 34 of the 145 ICAb-negative diabetics continuing on OHA did so at a mean follow-up of 5 yr 4 mo. (P < 0.02). Also 81 diabetics treated initially with diet for a mean time of 4 yr 7 mo. before going on to OHA therapy were studied. All were ICAb-negative when tested at a mean interval of 6 yr 10 mo. from diagnosis. By the end of the mean follow-up period of 10 yr 3 mo., 27 were on combined oral therapy and 3 were transferred to insulin treatment. ICAb-positive diabetics on OHA had a high prevalence of a personal history of organ-specific autoimmune disease, thyrogastric antibodies, a family history of insulin-dependent diabetes and possibly of an HL-A-B8 antigen prevalence comparable to that in insulin-dependent diabetes and higher than that expected in a control population or in diabetics controlled by diet alone. ICAb-positive diabetes controlled by OHA is probably an earlier stage in the same disease process (type-1 diabetes) that culminates in insulin-dependency.