Progression to type I diabetes in autoimmune endocrine patients with islet cell antibodies

In an 11-yr screening program carried out on serum samples sent to an autoimmune serology laboratory, 158 patients with clinical or subclinical autoimmune endocrine manifestations and islet cell antibodies (ICAs) in the absence of overt diabetes were identified and followed for the development of insulin-dependent (type I) diabetes. Twenty-two (13.9%) developed type I diabetes in a follow-up of up to 12 yr (mean +/- SE 4.8 +/- 3.2 yr). The probability of being free of type I diabetes was 69.8% at 10 yr after the first detection of ICAs. Progression to disease was influenced by 1) the amount of ICAs represented by high titers (63% of those with ICAs greater than or equal to 20 Juvenile Diabetes Foundation units being free of type I diabetes at 10 yr), ICA persistency (59% being free of type I diabetes; P less than 0.02 vs. nonpersistent ICA), and complement-fixing (CF)-ICAs (63% being free of type I diabetes; P less than 0.05 vs. non-CF-ICA); 2) the coexistence of insulin autoantibodies (IAAs) (25% being free of type I diabetes; P less than 0.005 vs. IAA-); and 3) a positive family history (1st-degree relative) for type I diabetes (32% being free of type I diabetes; P less than 0.005 vs. no family history). There was a trend for diabetes to develop earlier in males of a younger age. No relationships were found with the number, type, or clinical expression of the associated autoimmunities or with a family history of such disorders.(ABSTRACT TRUNCATED AT 250 WORDS)