Clinical and pathogenic significance of pancreatic-islet-cell antibodies in diabetics treated with oral hypoglycaemic agents

Lancet. 1977 May 14;1(8020):1025-7. doi: 10.1016/s0140-6736(77)91258-2.


20 out of 179 diabetics treated with oral hypoglycaemic agents (O.H.A.) within 3 mo of diagnosis had pancreatic-islet-cell antibodies (ICAb) in their sera at diagnosis or later. 13 of these 20, compared with only 14 of the remaining 159, subsequently required insulin at a mean follow-up of 2 yr 10 mo and 4 yr 11 mo, respectively (p less than 10(-7)). 5 of the 7 ICAb-positive diabetics still continuing on O.H.A. therapy after a mean follow-up of 4 yr 6 mo required maximum or near-maximum combined oral therapy, while only 34 of the 145 ICAb-negative diabetics continuing on O.H.A. did so at a mean follow-up of 5 yr 4 mo (p less than 0.02). In addition, 81 diabetics treated initially with diet for a mean time of 4 yr 7 mo before going on to O.H.A. therapy were studied. All were ICAb-negative when tested at a mean interval of 6 yr 10 mo from diagnosis. By the end of the mean follow-up period of 10 yr 3 mo, 27 were on combined oral therapy and 3 had been transferred to insulin treatment. ICAb-positive diabetics on O.H.A. had a high prevalence of a personal history of organ-specific autoimmune disease, thyrogastric antibodies, a family history of insulin-dependent diabetes and possibly of HLA-B8 comparable to that in insulin-dependent diabetes and higher than that expected in a control population or in diabetics controlled by diet alone. We believe that ICAb-positive diabetes controlled by O.H.A. is an earlier stage in the same disease process (type-I diabetes) that culminates in insulin-dependency.

Publication types

  • Comparative Study

MeSH terms

  • Administration, Oral
  • Adolescent
  • Adult
  • Aged
  • Autoantibodies / isolation & purification*
  • Autoimmune Diseases / immunology*
  • Biguanides / administration & dosage
  • Biguanides / therapeutic use
  • Body Weight
  • Diabetes Mellitus / drug therapy
  • Diabetes Mellitus / immunology*
  • Drug Therapy, Combination
  • Follow-Up Studies
  • Humans
  • Hypoglycemic Agents / administration & dosage*
  • Insulin / therapeutic use
  • Islets of Langerhans / immunology*
  • Middle Aged
  • Sulfonylurea Compounds / administration & dosage
  • Sulfonylurea Compounds / therapeutic use
  • Time Factors


  • Autoantibodies
  • Biguanides
  • Hypoglycemic Agents
  • Insulin
  • Sulfonylurea Compounds