Combined Measurement of Diabetes Mellitus Immunological Markers: an Assessment of its Benefits in Adult-Onset Patients

Abstract

The convenience of combining the measurement of antibodies to glutamic acid decru·boxylase (GADA), protein tyrosine phosphatase (IA-2A), and autoantibodies to insulin (IAA) in diabetic patients was assessed. We analysed 71 type l and 11 5 adult-onset diabetic patient. The latter were grouped into three categories according to the time of evolution to insulin dependence. The main findings were as follows: (i) in type I diabetes, the combined analysis of GADA and IA-2A showed a sensitivity of 87.4% and was not appreciably improved by adding IAA; (ii) out of 31 adults who required insulin immediately or wi thin the first two years of diagnosis, 41.9, 29.0, and 6.5% were positive for at least one, two or all three, and all three markers, respectively; GADA was the most prevalent (35.5%) and IA-2A the least represented (16.1%); (iii) 34 adult patients with slow evolution to insulin dependence bowed a completely different profile: 5.9% were GADA positive and 23.5% were IAA positive and no double or triple positivity was observed as all patients were IA-2A negative; and (iv) 50 type 2 patients who had not required insulin treatment showed a low incidence of GADA (4%) as the only marker present. We conclude that a combined double-antigen test for GADA and TA-2A is a useful strategy for prospective screening of type I diabetes. However, in adults, the profile of individual markers di scloses the course to insulin dependence. There fore, it seems advisable to measure the markers separately, to allow a better classification of these patients, and help define their treatment.