The Prevalence of Autoantibodies in Saudis Patients with Type 1 Diabetes Mellitus

K. S. Aljabri, S. A. Bokhari, K. Alqurashi

.
Department of Endocrinology, King Fahad Armed Forces Hospital, Jeddah, KSA.

DOI: 10.4236/ojemd.2013.32020                

Abstract

Background: Type 1 Diabetes mellitus (T1DM) results from a cellular-mediated autoimmune destruction of the β-cells of the pancreas. We designed this study to determine the prevalence of autoantibodies among Saudis patients with T1DM. Methods: Glutamic acid decarboxylase antibodies (GADA), antibodies to Islet cell (ICA) and Insulin (IAA) were measured in 171 Saudis patients with T1DM. Results: There were 171 patients with T1DM, 71 males (41.5%) and 100 females (58.5%). The mean age was 20.8 ± 6.6 and the mean diabetes duration was 7.7 ± 5.7. GADA, ICA and IAA were detected in 53.8%, 32.2% and 76% respectively. GADA, ICA and IAA were nonsignificantly more frequent in female and GADA and IAA were significantly more frequent in those younger than 20 years of age. Subjects testing positive for GADA had higher levels of ICA (42.4% vs. 20.3, p = 0.003) and IAA (79.3% vs. 72.2, p = 0.3) than those negative for GADA. Multiple antibodies (≥2) were observed more often in patients under the age of 20 years. There were nonsignificant differences in the prevalence of multiple antibodies between both genders. Multiple logistic regression analysis showed a significant independent positive relationship between the serum positivity of GADA, ICA and Multiple antibodies (≥2) with diabetes duration (0.02, p = 0.03, 0.02, p = 0.01 and 0.01, p = 0.04 respectively). Conclusions: The prevalence of autoantibodies in Saudi patients with T1DM is similar to those reported for diabetic patients in other ethnic groups.

Keywords

Type 1 Diabetes Mellitus; Autoantibodies; Prevalence; Saudi Arabia

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	M. Knip, “Disease-Associated Autoimmunity and Prevention of Insulin-Dependent Diabetes Mellitus,” Annals of Medicine, Vol. 29, No. 5, 1997, pp. 447-451. doi:10.3109/07853899708999375
[2]	H. Kolb, K. Dannehl and D. Gruneklee, “Prospective Analysis of Islet Cell Antibodies in Children with Type 1 (Insulindependent) Diabetes,” Diabetologia, Vol. 31, No. 4, 1988, pp. 189-194. doi:10.1007/BF00290583
[3]	M. R. Batstra, M. Pina, J. Quan, et al., “Fluctuations in GAD65 Antibodies after Clinical Diagnosis of IDDM in Young Children,” Diabetes Care, Vol. 20, No. 4, 1997, pp. 642-644. doi:10.2337/diacare.20.4.642
[4]	M. Landin-Olsson, J. P. Palmer, A. Lernmarks, L. Blom, G. Sundkvist, L. Nystrm and G. Dahlquist, “Predictive Value of Islet Cell and Insulin Autoantibodies for Type 1 (Insulin-Dependent) Diabetes Mellitus in a Population-Based Study of Newly-Diagnosed Diabetic and Matched Control Children,” Diabetologia, Vol. 35, No. 11, 1992, pp. 1068-1073. doi:10.1007/BF02221683
[5]	A. L. Notkins and A. Lernmark, “Autoimmune Type 1 Diabetes: Resolved and Unresolved Issues,” Journal of Clinical Investigation, Vol. 108, No. 9, 2001, pp. 1247-1252.
[6]	E. Kawasaki and K. Eguchi, “Is Type 1 Diabetes in the Japanese Population the Same as among Caucasians?” Annals of the New York Academy of Sciences, Vol. 1037, 2004, pp. 96-103. doi:10.1196/annals.1337.014
[7]	T. Kobayashi, S. Sawano, T. Itoh, T. Sugimoto, T. Tanaka and S. Suwa, “The Prevalence of Islet-Cell Antibodies and Complement-Fixing Islet-Cell Antibodies in Japanese Diabetics,” Endocrinologia Japonica, Vol. 28, No. 4, 1981, pp. 429-433. doi:10.1507/endocrj1954.28.429
[8]	Y. S. Lee, W. Y. Ng, A. C. Thai, K. F. Lui and K. Y. Loke, “Prevalence of ICA and GAD Antibodies at Initial Presentation of Type 1 Diabetes Mellitus in Singapore Children,” Journal of Pediatric Endocrinology and Metabolism, Vol. 14, No. 6, 2001, pp. 767-772. doi:10.1515/JPEM.2001.14.6.767
[9]	A. L. Todd, W. Y. Ng, K. F. Lui and A. C. Thai, “Low Prevalence of Autoimmune Diabetes Markers in a Mixed Ethnic Population of Singaporean Diabetics,” Internal Medicine Journal, Vol. 34, No. 1-2, 2004, pp. 24-30. doi:10.1111/j.1444-0903.2004.00482.x
[10]	D. G. McLarty, I. Athaide, G. F. Bottazzo, A. M. Swai and K. G. Alberti, “Islet Cell Antibodies Are Not Specifically Associated with Insulindependent Diabetes in Tanzanian Africans,” Diabetes Research and Clinical Practice, Vol. 9, No. 3, 1990, pp. 219-224. doi:10.1016/0168-8227(90)90048-X
[11]	J. M. Oli, G. F. Bottazzo and D. Doniach, “Islet Cell Antibodies and Diabetes in Nigerians,” Tropical and Geographical Medicine, Vol. 33, No. 2, 1981, pp. 161-164.
[12]	M. A. Omar, G. Bottazzo and A. C. Asmal, “Islet Cell Antibodies and Other Autoantibodies in South African Blacks and INDIANS with Insulin Dependent Diabetes Mellitus (IDDM),” Hormone and Metabolic Research, Vol. 18, No. 2, 1986, pp. 126-128. doi:10.1055/s-2007-1012247
[13]	W. H. Peters, F. T. Lester, K. D. Kohnert and W. Hildmann, “The Frequency of Islet Cell Surface Antibodies in Newly Diagnosed Diabetics from Ethiopia,” Experimental and Clinical Endocrinology, Vol. 87, No. 3, 1986, pp. 326-332. doi:10.1055/s-0029-1210562
[14]	V. R. Panz, W. J. Kalk, M. Zouvanis and B. I. Joffe, “Distribution of Autoantibodies to Glutamic Acid Decarboxylase across the Spectrum of Diabetes Mellitus Seen in South Africa,” Diabetic Medicine, Vol. 17, No. 3, 2000, pp. 524-527. doi:10.1046/j.1464-5491.2000.00324.x
[15]	M. Neufeld, N. K. Maclaren, W. J. Riley, D. Lezotte, J. V. McLaughlin, J. Silverstein and A. L. Rosenbloom, “Islet Cell and Other Organ-Specific Antibodies in U.S. Caucasians and Blacks with Insulin-Dependent Diabetes Mellitus,” Diabetes, Vol. 29, 1980, pp. 589-592. doi:10.2337/diabetes.29.8.589
[16]	I. M. Libman, M. Pietropaolo, M. Trucco, J. S. Dorman, R. E. LaPorte and D. Becker, “Islet Cell Autoimmunity in White and Black Children and Adolescents with IDDM,” Diabetes Care, Vol. 21, No. 11, 1998, pp. 1824-1827.
[17]	N. A. Kulaylat and H. Narchi, “A Twelve Year Study of the Incidence of Childhood Type 1 Diabetes Mellitus in the Eastern Province of Saudi Arabia,” Journal of Pediatric Endocrinology and Metabolism, Vol. 13, No. 2, 2000, pp. 135-140.
[18]	O. S. Al-Attas, M. A. Laajam and M. S. Khan, “Freqency of Islet Cell Antibodies in Adult Newly Diagnosed Diabetic Patients,” Annals of Saudi Medicine, Vol. 10, 1990, pp. 369-373.
[19]	L. H. Damanhouh, J. A. Dromey, M. R. Christie, H. A. Nasrat, M. S. M. Ardawi, R. A. Robins and I. Todd, “Autoantibodies to GAD and IA-2 in Saudi Arabian Diabetic Patients,” Diabetic Medicine, Vol. 22, No. 4, 2005, pp. 448-452. doi:10.1111/j.1464-5491.2005.01438.x
[20]	American Diabetes Association, “Diagnosis and Classification of Diabetes Mellitus,” Diabetes Care, Vol. 33, 2010, pp. S62-S69. doi:10.2337/dc10-S062
[21]	G. Blohmé, L. Nystrom, H. J. Arnqvist, F. Lithner, B. Littorin, P. O. Olsson, B. Scherstén, L. Wibell and J. Ostman, “Male Predominance of Type 1 (Insulin-Dependent) Diabetes Mellitus in Young Adults: Results from a 5-Year Prospective Nationwide Study of the 15 - 34-Year Age Group in Sweden,” Diabetologia, Vol. 35, No. 1, 1992, pp. 56-62.
[22]	W. A. Hagopian, G. B. Sanjeevi, I. Kockum, M. Landin-Olsson, A. E. Karlsen, G. Sundkvist, et al., “Glutamate Decarboxylase-, Insulin-, and Islet Cell-Antibodies and HLA Typing to Detect Diabetes in a General Population-Based Study of Swedish Children,” Journal of Clinical Investigation, Vol. 95, No. 4, 1995, pp. 1505-1511. doi:10.1172/JCI117822
[23]	J. R. Bilbao, I. Rica, J. A. Vazquez, M. A. Busturia and L. Castano, “Influence of Sex and Age at Onset on Autoantibodies against Insulin, GAD65 and 1A2 in Recent Onset Type 1 Diabetic Patients,” Hormone Research, Vol. 54, 2000, pp. 181-185. doi:10.1159/000053256
[24]	A. Williams, A. Norcross, R. Dix, K. Gillespie, E. Gale and P. Bingley, “The Prevalence of Insulin Autoantibodies at the Onset of Type 1 Diabetes Is Higher in Males than Females during Adolescence,” Diabetologia, Vol. 46, No. 10, 2003, pp. 1354-1356. doi:10.1007/s00125-003-1197-2