Rising incidence of type 1 diabetes is associated with altered immunophenotype at diagnosis

Abstract

The incidence of type 1 diabetes has increased rapidly over recent decades, particularly in young children. We aimed to determine whether this rise was associated with changes in patterns of humoral islet autoimmunity at diagnosis. Autoantibodies to insulin (IAA), GAD (GADA), islet antigen-2 (IA-2A), and zinc transporter 8 (ZnT8A) were measured by radioimmunoassay in sera collected from children and young adults with newly diagnosed type 1 diabetes between 1985 and 2002. The influence of date of diagnosis on prevalence and level of autoantibodies was investigated by logistic regression with adjustment for age and HLA class II genetic risk. Prevalence of IA-2A and ZnT8A increased significantly over the period studied, and this was mirrored by raised levels of IA-2A, ZnT8A, and IA-2β autoantibodies (IA-2βA). IAA and GADA prevalence and levels did not change. Increases in IA-2A, ZnT8A, and IA-2βA at diagnosis during a period of rising incidence suggest that the process leading to type 1 diabetes is now characterized by a more intense humoral autoimmune response. Understanding how changes in environment or lifestyle alter the humoral autoimmune response to islet antigens should help explain why the incidence of type 1 diabetes is increasing and may suggest new strategies for preventing disease.

FIG. 1.

Plots showing IA-2A (A), IA-2βA (tested in IA-2A–positive patients) (B), ZnT8RA (C), ZnT8WA (D), IAA (E), and GADA (F) levels for four quartiles based on date of diagnosis. Median antibody levels are shown by the line in the box, the interquartile range is represented by the box, and the whiskers represent 1.5 times the interquartile range. The levels of IAA and GADA were stable, but levels of IA-2A, ZnT8RA, ZnT8WA, and IA-2βA increased significantly with diagnosis quartile.