The Prediction of Type 1 Diabetes Development and Diagnosis of Its Asymptomatic Phase Using Autoantibodies to Human Islets of Langerhans Long Before the Onset of the Disease
Keywords:type 1 diabetes mellitus, immunity, autoantibodies to pancreatic beta-cells, preclinical diagnosis, prediction
The article deals with an analysis of the latest data of world literature and the results of own twenty-year researches on studying antibodies to human islets of Langerhans, and their use as a test for predicting the risk of type 1 diabetes mellitus (DM), and diagnosis of asymptomatic phase of its development in normoglycemic children of Ukraine. The majority of foreign diabetologists adhere to the same opinion that the determination of islet autoantibodies (IAA) of ICA, IAA, GADA, IA‑2A and ZnT8 in human blood serum has the high diagnostic value and specificity for detecting the autoimmune destructive process in islets, starting with the very early asymptomatic phase of DM development, long before (sometimes months or years before) the manifestation of clinical symptoms of the disease in normoglycemic person. In the simultaneous detection of positivity to the majority of IAA, the development of type 1 DM is inevitable. Our observations, performed for the first time with the participation of children of Ukraine, fully confirm this conclusion. The accuracy of predicting the risk of DM is directly related to the number of different types of IAA, which are used simultaneously, — the more of them, the higher the accuracy of the prediction, and also it is associated with HLA-DR-DQ genotype, the age of the examined person, autoantibodies titer, and the time that has elapsed after the first positive test. With the simultaneous screening of four to five IAA, the accuracy of DM prediction exceeds 90 %. A characteristic feature of IAA is the variability of their titer in the blood, i.e. its increase is alternated with reversion to a normal level. At the same time, IAA are used to detect remaining residual beta cells in the pancreas late after insulin therapy that is necessary for the assignment of more effective immunologic intervention, as well as for more precise differentiation between type 1 and type 2 DM in adults.
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