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Islet autoantibodies can discriminate maturity-onset diabetes of the young (MODY) from Type1 diabetes
Diabetic Medicine, 09/06/2011
McDonald TJ et al. – The prevalence of glutamate decarboxylase (GAD) and islet antigen–2 (IA–2) antibodies in maturity–onset diabetes of the young is the same as in control subjects (< 1%). The finding of islet autoantibodies, especially IA–2 antibodies, makes the diagnosis of maturity–onset diabetes of the young very unlikely and genetic testing should only be performed if other clinical characteristics strongly suggest this form of diabetes rather than Type 1 diabetes. This supports routine islet autoantibody testing before proceeding to more expensive molecular genetic testing.
Methods- The authors measured plasma GAD and IA–2 antibodies in 508 patients with the most common forms of maturity–onset diabetes of the young (GCK: n=227; HNF1A: n=229; HNF4A: n=52) and 98 patients with newly diagnosed Type 1 diabetes (diagnosed <6months). Autoantibodies were considered positive if ≥99th centile of 500 adult control subjects.
- GAD and/or IA–2 antibodies were present in 80/98 (82%) patients with Type 1 diabetes and 5/508 (<1%) patients with maturity–onset diabetes of the young.
- In the cohort with Type 1 diabetes, both GAD and IA–2 antibodies were detected in 37.8% of patients, GAD only in 24.5% and IA–2 only in 19.4%.
- All five patients with maturity–onset diabetes of the young with detectable antibodies had GAD antibodies and none had detectable IA–2 antibodies.
