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High prevalence of idiopathic (islet antibody-negative) type 1 diabetes among Indian children and adolescents

机译：认证性（胰岛抗体阴性）的高患病率1型印度儿童和青少年中的1型糖尿病

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Objectives To study the prevalence and clinical characteristics of islet antibody-negative (idiopathic) type 1 diabetes mellitus (T1DM) among Indian children and adolescents at the time of diagnosis of illness. Methods In a hospital-based cross-sectional study, we studied 110 patients with T1DM aged <= 18 years. This included 61 patients with duration of diabetes <= 2 weeks (mean +/- SD age of onset 9.9 +/- 4.4 years) and 49 patients with duration 2 to 12 weeks. Antibodies against GAD65 (GADA), IA-2 (IA-2A) and zinc transporter 8 (ZnT8A), detected by radio-binding assay, were measured in all patients. Insulin autoantibody (IAA) was measured only in subjects with duration <= 2 weeks, using a competitive radio-binding assay. Results The prevalence of GADA, IA-2A, and ZnT8A was 53%, 34%, and 29% respectively, while IAA (measured in 61 patients) was detected in 31%. All four antibodies were absent in 17 of 61 (28%) patients. The prevalence of islet antibody-negative patients was similar among both sexes and in children with onset younger and older than 10 years. ZnT8A was the only antibody detected in four patients, and its measurement resulted in 6% reduction in islet antibody-negative patients. Patients with idiopathic T1DM did not differ in their clinical features or fasting plasma C-peptide at the onset and after follow-up of 1 year. Compared with idiopathic T1DM, antibody-positive patients had an increased allele frequency of HLA DRB1*0301 (46% vs 14%, OR = 5.10 [confidence interval = 1.61-16.16],P= .003). Conclusion Nearly 30% of Indian patients were negative for all islet antibodies at the onset of T1DM. Patients with idiopathic T1DM had similar clinical features to antibody-positive subjects.
机译：目的研究印度儿童和青少年诊断为胰岛抗体阴性（特发性）1型糖尿病（T1DM）时的患病率和临床特征。方法在一项基于医院的横断面研究中，我们研究了110例年龄小于等于18岁的T1DM患者。这包括61名糖尿病持续时间小于等于2周（平均发病年龄+/-SD为9.9+/-4.4岁）的患者和49名持续时间为2至12周的患者。通过放射结合试验检测所有患者的GAD65（GADA）、IA-2（IA-2A）和锌转运蛋白8（ZnT8A）抗体。胰岛素自身抗体（IAA）仅在持续时间小于等于2周的受试者中使用竞争性放射结合试验进行测量。结果GADA、IA-2A和ZnT8A的患病率分别为53%、34%和29%，而IAA（在61例患者中测量）的检出率为31%。61名患者中有17名（28%）没有这四种抗体。胰岛抗体阴性患者的患病率在男女之间以及在发病年龄小于或大于10岁的儿童中相似。ZnT8A是在四名患者中检测到的唯一抗体，其测量结果导致胰岛抗体阴性患者减少6%。特发性T1DM患者在发病时和随访1年后的临床特征或空腹血浆C肽没有差异。与特发性T1DM相比，抗体阳性患者的HLA DRB1*0301等位基因频率增加（46%比14%，OR=5.10[置信区间=1.61-16.16]，P=0.003）。结论近30%的印度患者在T1DM发病时所有胰岛抗体均为阴性。特发性T1DM患者的临床特征与抗体阳性受试者相似。

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