Insulin binding antibodies and their relation to clinical and metabolic markers in type 1 diabetic children and adolescents
Journal Title: Przegląd Pediatryczny - Year 2008, Vol 38, Issue 1
Abstract
The aims of the study were: 1. to evaluate the levels of insulin antibodies (IA) during the first 2 years of type 1 diabetes in children and adolescents, 2. to analyze relations between IA and several clinical and metabolic markers. Material and methods: Fifty seven patients (37 males and 20 females) aged 7.6-17.9 years (mean 13.2±2.4) participated in the study. Patients were treated with human insulins and/or with rapid acting human insulin analogs. During the 1st week after diabetes diagnosis, 6 months after diagnosis (N=57) and 24 months after diagnosis (N=42) the following parameters were studied: residual insulin secretion, daily insulin dose, HbA1c, BMI and insulin sensitivity. IA were measured by radioimmunoprecipitation (normal values <7%), C-peptide was measured by radioimmunoassay (the increase in C-peptide concentration 6 minutes after an intravenous injection of glucagon was measured, AC-pep). M index measured by euglycemic hyperinsulinemic clamp method by DeFronzo was the measure of insulin sensitivity (higher M index indicates higher insulin sensitivity). Results: Median values (and quartiles) of IA were: 6.7% (5.6-7.4), 16.6% (10.2-37.1) and 17.0% (9.4-38.9) respectively in the 1st week of diabetes and after 6 and 24 months of follow up. IA levels rose significantly during the first 6 months of diabetes (p<0.0001) and remained stable there after. After 6 months of diabetes duration the following statistically significant correlations were found: negative between IA and AC-pep (r=-0.36, p=0.007), positive between IA and M index (r=0.27, p=0.04) and negative between IAand BMI (p=-0.4, p=0.02); a slight, statistically nonsignificant, correlation between IA and daily insulin dose was noted, too (r=0.19, p=0.16). After 24 months correlation coefficients were as follows: for IA and M index p=0.16, p=0.32, for IA and AC-pep p=-0.08, p=ns, for IA and BMI p=-0.34, p=0.03. Conclusions: 1. Modern insulin preparations induce production of IA in young type 1 diabetic patients. 2. Patients with lower residual insulin secretion require higher daily insulin doses during the first months of diabetes, which may preclude higher IA production. 3. Negative correlation between IA and insulin resistance may be a) secondary to the well known correlation: lower BMI - higher insulin sensitivity or may be due to b) IA acting as a temporary "reservoir" of administered insulin or to c) hypoglycemic activity of IA - insulin complexes.
Authors and Affiliations
Beata Mianowska, Agnieszka Szadkowska, Iwona Pietrzak, Elżbieta Czerniawska, Olga Wegner, Krystyna Wyka, Jerzy Bodalski, Wojciech Młynarski
Keywords
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