详细记录  
题名:Insulin secretion and sensitivity in the prediction of type 1 diabetes in children with advanced beta-cell autoimmunity.
作者:SILJANDER HT; HERMANN R; HEKKALA A; LAHDE J; TANNER L; KESKINEN P; ILONEN J; SIMELL O; VEIJOLA R; KNIP M;
来源:Eur J Endocrinol. 2013 Sep 14;169(4):479-85. doi: 10.1530/EJE-13-0206. Print 2013 [ IF= 0.00 ] ]
URL :10.1530/EJE-13-0206
日期:20131002
摘要:OBJECTIVE: Reduced early insulin response has been shown to predict type 1
diabetes (T1D) in first-degree relatives of diabetic patients, while its role, as
well as that of insulin resistance, has remained poorly defined in young children
representing the general population. The predictive values of these markers and
their relation to other risk factors of T1D were assessed in children with
advanced beta-cell autoimmunity, i.e. persistent positivity for two or more
autoantibodies. DESIGN AND METHODS: Intravenous glucose tolerance tests (IVGTTs)
were carried out in 218 children with HLA-DQB1-conferred disease susceptibility
and advanced beta-cell autoimmunity. Baseline, metabolic and growth data were
compared between children progressing to diabetes and those remaining unaffected.
Hazard ratios for the disease predictors and the progression rate of T1D were
assessed. RESULTS: Children developing T1D were younger at seroconversion,
progressed more rapidly to advanced beta-cell autoimmunity and had lower
first-phase insulin response (FPIR) and homeostasis model assessment index for
insulin resistance (HOMA-IR) than those remaining non-diabetic. The levels of
HOMA-IR/FPIR, islet cell antibodies, insulin autoantibodies (IAA) and islet
antigen 2 antibodies (IA-2A) were higher in progressors. BMI SDS, FPIR, age at
IVGTT and levels of IAA and IA-2A were predictive markers for T1D. CONCLUSIONS:
Young age, higher BMI SDS, reduced FPIR and higher levels of IAA and IA-2A
predicted T1D in young children with HLA-DQB1-conferred disease susceptibility
and advanced beta-cell autoimmunity. Disease risk estimates were successfully
stratified by the assessment of metabolic status and BMI. The role of insulin
resistance as an accelerator of the disease process was minor.

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