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

Abstract

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.

The Prevalence of Islet Autoantibodies in Children and Adolescents With Type 1 Diabetes Mellitus: A Global Scoping Review

“…Children and adolescents with a first degree relative with type 1 diabetes have a 15-fold increased relative risk of type 1 diabetes, which helps to inform screening policies, but there is scant guidelines on who else to screen and how to identify the population at risk (20)(21)(22). Further, although iAb are routinely used to define pre-clinical type 1 diabetes, the reported prevalence of idiopathic type 1 diabetes (iAb-) is high in some studies (23,24). A global picture of iAb prevalence and profiles with respect to DKA risk, C-peptide levels and associated morbidity and mortality, is lacking from the literature.…”

Glutamic Acid Decarboxylase and Tyrosine Phosphatase-Related Islet Antigen-2 Positivity among Children and Adolescents with Diabetes in Korea

“…GADA, autoantibody to glutamic acid decarboxylase; IA2A, autoantibody to tyrosine phosphatase-related islet antigen 2; INSA, insulin autoantibody; ICA, autoantibody to islet cells. (34.0% to 41.1%) has been reported in Asian countries [8,9]. In previous studies conducted in Korea, the positivity rates of one or more of the GADA and INSA were 66.7% in T1DM patients [10].…”

Childhood and adolescent diabetes in the Indian subcontinent: A glass half full

“…[9][10][11] While the frequency of antibodies against the antigen glutamic acid decarboxylase (GAD) is similar to that encountered in the T1DM children of European ancestry, the prevalence of tyrosine phosphatase (IA2) and zinc transporter 8 (ZnT8) antibodies are considerably lower. 9 Among other unique variants of diabetes encountered in late adolescence and in young adults is fibrocalculous pancreatic diabetes (FCPD). 13,14 Earlier thought to result from free radical damage to islets by cyanogenic glycosides in foods like tapioca (cassava), FCPD has been shown to have a genetic predisposition in a small proportion of patients.…”

“…Within T1DM, islet antibody positivity is well documented to be lower (65%-70%) among recent onset T1DM patients from India than the 90% positivity observed in European populations. [9][10][11] While the frequency of antibodies against the antigen glutamic acid decarboxylase (GAD) is similar to that encountered in the T1DM children of European ancestry, the prevalence of tyrosine phosphatase (IA2) and zinc transporter 8 (ZnT8) antibodies are considerably lower. 9 The HLA associations in north Indian patients show the HLA-DRB1*03/ DQB1*02 (DR3/DQ2) to be strongly associated with T1DM, as in their European counterparts.…”

“…Data on etiological aspects of childhood and adolescent diabetes in India provide interesting comparisons with patients of European descent. Within T1DM, islet antibody positivity is well documented to be lower (65%‐70%) among recent onset T1DM patients from India than the 90% positivity observed in European populations 9‐11 . While the frequency of antibodies against the antigen glutamic acid decarboxylase (GAD) is similar to that encountered in the T1DM children of European ancestry, the prevalence of tyrosine phosphatase (IA2) and zinc transporter 8 (ZnT8) antibodies are considerably lower 9 .…”