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Insulin antibodies in diabetic children before treatment: a marker for islet B-cell destruction?
C E De Beaufort1, C Binder, G J Bruining
1Department of Paediatrics, Erasmus University, Rotterdam, The Netherlands.
Insights
Insulin antibodies are common in children with new-onset diabetes. Early insulin antibodies may predict lower endogenous insulin production after one year of therapy.
Area of Science:
- Pediatric Endocrinology
- Immunology
- Diabetes Mellitus
Background:
- Insulin antibodies can develop in patients treated with insulin.
- The impact of pre-existing insulin antibodies on endogenous insulin production in children with diabetes is not well understood.
Purpose of the Study:
- To investigate the prevalence of insulin antibodies in newly diagnosed diabetic children.
- To assess the relationship between insulin antibodies and endogenous insulin production before and after one year of insulin therapy.
Main Methods:
- Sera from 28 newly diagnosed diabetic children were analyzed for insulin antibodies.
- Endogenous insulin production was evaluated using 24-hour urinary C-peptide excretion and plasma C-peptide levels.
- Measurements were taken before and at various time points up to 12 months after initiating insulin therapy.
Main Results:
- Insulin antibodies were detected in 29% of patients at diagnosis and in 96% after one year.
- No correlation was found between insulin antibodies at diagnosis and age or initial C-peptide excretion.
- Children with insulin antibodies before therapy showed significantly lower urinary C-peptide excretion after one year.
Conclusions:
- Insulin antibodies are frequently observed in children with new-onset type 1 diabetes.
- Pre-therapy insulin antibodies may be associated with a diminished capacity for endogenous insulin production following treatment initiation.
Abstract:
Insulin antibodies were measured in the sera of 28 newly diagnosed diabetic children (age 8.0 +/- 4.0 (+/- SD) years) prior to insulin therapy and after 3, 6, 9, and 12 months. The levels at diagnosis and after 12 months were compared to endogenous insulin production at onset and after 12 to 14 months. Endogenous insulin production was evaluated through the measurement of 24-h urinary C-peptide excretion, fasting plasma C-peptide levels and plasma C-peptide levels after glucagon stimulation. Insulin antibodies were detected in 29% of the patients (8 out of 28). In all but one patient antibodies binding porcine and human insulin were detected. No relationship was found between the presence of antibodies binding human or porcine insulin at diagnosis and age. After 1 year 27 out of 28 patients presented insulin antibodies. No relationship was found between the presence of insulin antibodies before therapy and 1 year after therapy. Insulin antibodies prior to diagnosis showed no relationship with the urinary C-peptide excretion at diagnosis (with antibodies 67 +/- 27%, without antibodies 76 +/- 11%). However, after 1 year significantly lower urinary C-peptide excretions were found in patients with insulin antibodies prior to therapy (with antibodies, 17 +/- 7%, without antibodies, 31 +/- 5%, p less than 0.02). Peak plasma C-peptide levels after 1 year were possibly lower in patients with insulin antibodies before treatment (with antibodies 0.17 +/- 0.06 nmol/l, without antibodies 0.26 +/- 0.04 nmol/l, p less than 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)