A1 Refereed original research article in a scientific journal
An Age-Related Exponential Decline in the Risk of Multiple Islet Autoantibody Seroconversion During Childhood
Authors: Bonifacio Ezio, Weiß Andreas, Winkler Christiane, Hippich Markus, Rewers Marian J., Toppari Jorma, Lernmark Åke, She Jin-Xiong, Hagopian William A., Krischer Jeffrey P., Vehik Kendra, Schatz Desmond A., Akolkar Beena, Ziegler Anette-Gabriele; TEDDY Study Group
Publisher: American Diabetes Association
Publication year: 2021
Journal: Diabetes Care
Journal name in source: DIABETES CARE
Journal acronym: DIABETES CARE
Volume: 44
Issue: 10
First page : 2260
Last page: 2268
Number of pages: 9
ISSN: 0149-5992
DOI: https://doi.org/10.2337/dc20-2122
Web address : https://diabetesjournals.org/care/article/44/10/2260/138553/An-Age-Related-Exponential-Decline-in-the-Risk-of
OBJECTIVE
Islet autoimmunity develops before clinical type 1 diabetes and includes multiple and single autoantibody phenotypes. The objective was to determine age-related risks of islet autoantibodies that reflect etiology and improve screening for presymptomatic type 1 diabetes.
RESEARCH DESIGN AND METHODS
The Environmental Determinants of Diabetes in the Young study prospectively monitored 8,556 genetically at-risk children at 3- to 6-month intervals from birth for the development of islet autoantibodies and type 1 diabetes. The age-related change in the risk of developing islet autoantibodies was determined using landmark and regression models.
RESULTS
The 5-year risk of developing multiple islet autoantibodies was 4.3% (95% CI 3.8–4.7) at 7.5 months of age and declined to 1.1% (95% CI 0.8–1.3) at a landmark age of 6.25 years (P < 0.0001). Risk decline was slight or absent in single insulin and GAD autoantibody phenotypes. The influence of sex, HLA, and other susceptibility genes on risk subsided with increasing age and was abrogated by age 6 years. Highest sensitivity and positive predictive value of multiple islet autoantibody phenotypes for type 1 diabetes was achieved by autoantibody screening at 2 years and again at 5–7 years of age.
CONCLUSIONS
The risk of developing islet autoimmunity declines exponentially with age, and the influence of major genetic factors on this risk is limited to the first few years of life.
