presence of multiple autoantibodies and its relation to the control of diabetic patients under therapy

ABSTRACT

The presence of multiple autoantibodies to different islet cell antigen including those to insulin autoantibodies [IAA] islet cell cytoplasm [ICA] and glutamic acid decarboxylase [GAD-Ab] were studied in 70 diabetic patients [30 cases of type I diabetes [IDDM], 30 cases of type II [NIDDM], 10 cases shifted from oral hypoglycemic therapy to insulin, in addition to 20 normal healthy controls]. All were subjected to fasting and postprandial plasma glucose, C-peptide level, glycosylated hemoglobin, insulin antibodies, islet cell cytoplasmic antibodies and glutamic acid decarboxylase antibodies. The obtained results showed that in IDDM group, 23.3% were positive for ICA, 40% were positive for GAD-Ab and 60% were positive for IAA. In NIDDM group, 23.7% were positive for ICA, 36.7% positive for GAD-Ab and 50% were positive for IAA. In the group of patients who shifted recently to insulin therapy, 30% were positive for ICA, 30% positive for GAD-Ab and 90% were positive for IAA. There was a positive correlation between glycosylated hemoglobin with the number of positive antibodies. Cases with no positive antibodies had a significant lower glycosylated hemoglobin level than those with one or more positive antibodies. It was concluded that the presence of both ICA and GAD-Ab was a stronger predictor of rapid B cell loss; hence, there was a more need for insulin therapy