Aim: Previous studies have shown that diabetes associated antibodies are present in 8590% of patients with Type 1 diabetes. NICE guidelines do not suggest routine use of antibodies screening at initial presentation. The aim of our study was to identify the incidence of antibody positivity in our centre and also review the clinical profile of children diagnosed with diabetes who were antibodies negative.
Method: Retrospective case notes review of 243 newly diagnosed diabetic children (<18 years) between January 2010 and December 2016. The children were tested for Islet cell antibody, Anti-GAD antibody and IA2 antibodies.
Results: Diabetes autoantibodies testing was done in 224/243 patients (92.2%). 187/224 (83.48%) tested positive for diabetes autoantibody. 53 patients had three autoantibodies present; 69 had two autoantibodies present and 65 had one autoantibody present, confirming the diagnosis of Type 1 diabetes. Remaining 37 (16.5%) tested negative for antibodies. 24/37 children were presumed type 1 diabetes; 8 children had Type 2 diabetes, all of them obese with median BMI 34 kg/m2, 1 child had Maturity onset diabetes of the Young, 2 had drug induced diabetes, 1 had permanent neonatal diabetes and 1 had diabetes secondary to pancreatitis. Eight out of 24 patients treated as Type1 diabetes presented in DKA (32%) at diagnosis. Rest 16 patients were noted to have median insulin requirement of 0.8 units/kg/day during follow-up after 1 year. We compared autoantibody positive and negative groups in children with type 1 diabetes; no difference was noted in the mean age at diagnosis (8.8 vs 8.9 years), DKA at presentation (31.5% vs 32%) and mean HbA1C levels at presentation (99 vs 97 mmol/mol).
Conclusion: 187 out of 211 (88.7%) children and young people with type 1 diabetes have at least 1 positive diabetes antibodies in line with incidence reported in the literature. There was no significant difference between antibody positive and negative type 1 diabetes children. Children diagnosed as Type 1 diabetes that are antibody negative will need further evaluation if there is no natural history of type 1 diabetes.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes