Multiple Islet Autoantibodies in Childhood Indicates Diabetic Destiny Interview with:  Dr. Ezio Bonifacio, Ph.D.
Professor, Preclinical Stem Cells/Diabetes
Center for Regenerative Therapies Dresden
Technische Universität Dresden  What are the main findings of the study?

Dr. Bonifacio: Children who develop multiple islet autoantibodies are destined to develop diabetes. Only a minority will be diabetes-free 15 years after developing islet autoantibodies. This is regardless of whether they have a family history of type 1 diabetes. Progression to diabetes after seroconversion varied from weeks to decades, and 20% of children had diabetes within 2 years from seroconverting. Progression was fastest in children who developed their islet autoantibodies before age 3 years.  Were any of the findings unexpected?

Dr. Bonifacio: Unexpected is probably not the right word. The Eisenbarth model of chronic disease proposes that diabetes will happen some time after autoimmunity and the findings show the reality of it. Perhaps the unexpected finding is that it is not always chronic and that for a number of children, intervention would need to be applied quickly.  What should clinicians and patients take away from your report?

Dr. Bonifacio: That type 1 diabetes can be pre-diagnosed. Waiting to see when children with multiple islet autoantibodies will develop diabetes is not a great option. Identifying the children provides an opportunity to prevent acute disease complications, and we hope that it will eventually provide the opportunity to identify a therapy that will delay or prevent the onset of diabetes.  What recommendations do you have for future research as a result of this study?

Dr. Bonifacio: The time taken to develop diabetes was incredibly variable. While some children developed diabetes within weeks of seroconversion, many took 10 years of more. Understanding what naturally delays disease onset would be very helpful. And of course, we should intensify our efforts to find prevention therapies. The findings show that any person with multiple islet autoantibodies, and not just persons with a family history of type 1 diabetes, is a candidate for therapy. This markedly increases the number of persons who we can include into trials. We have an obligation to work on cost effective screening programs to identify these children and an obligation to rigorously put potential prevention therapies to the test in animal models and man.


Seroconversion to Multiple Islet Autoantibodies and Risk of Progression to Diabetes in Children

Ziegler AG, Rewers M, Simell O, et al. Seroconversion to Multiple Islet Autoantibodies and Risk of Progression to Diabetes in Children. JAMA. 2013;309(23):2473-2479. doi:10.1001/jama.2013.6285.

Last Updated on September 19, 2013 by Marie Benz MD FAAD