Cited by 185Diabetes and associated disordersDiabetes Management and ResearchT-cell and B-cell Immunology

Predictors of progression from the appearance of islet autoantibodies to early childhood diabetes: the environmental determinants of diabetes in the young (TEDDY)

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Steck, Andrea K., Vehik, Kendra, Bonifacio, Ezio, Lernmark, Ake, Ziegler, Anette-G., Hagopian, William A., She, JinXiong, Simell, Olli +5 more·2015·Diabetes Care

Abstract

OBJECTIVE: While it is known that there is progression to diabetes in <10 years in 70% of children with two or more islet autoantibodies, predictors of the progression to diabetes are only partially defined. RESEARCH DESIGN AND METHODS: The Environmental Determinants of Diabetes in the Young (TEDDY) study has observed 8,503 children who were at increased genetic risk for autoimmune diabetes. Insulin autoantibodies (IAAs), GAD65 autoantibodies (GADAs), and insulinoma-associated protein 2 autoantibodies (IA-2As) were measured every 3 months until 4 years of age and every 6 months thereafter; if results were positive, the autoantibodies were measured every 3 months. RESULTS: Life table analysis revealed that the cumulative incidence of diabetes by 5 years since the appearance of the first autoantibody differed significantly by the number of positive autoantibodies (47%, 36%, and 11%, respectively, in those with three autoantibodies, two autoantibodies, and one autoantibody, P < 0.001). In time-varying survival models adjusted for first-degree relative status, number of autoantibodies, age at first persistent confirmed autoantibodies, and HLA genotypes, higher mean IAA and IA-2A levels were associated with an increased risk of type 1 diabetes in children who were persistently autoantibody positive (IAAs: hazard ratio [HR] 8.1 [95% CI 4.6–14.2]; IA-2A: HR 7.4 [95% CI 4.3–12.6]; P < 0.0001]). The mean GADA level did not significantly affect the risk of diabetes. CONCLUSIONS: In the TEDDY study, children who have progressed to diabetes usually expressed two or more autoantibodies. Higher IAA and IA-2A levels, but not GADA levels, increased the risk of diabetes in those children who were persistently autoantibody positive.

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  • Autoantibody markers plus clinical presentation can help distinguish type 1 from type 2 diabetes in children and adults.

    “The presence or absence of autoimmune markers (autoantibodies to glutamic acid decarboxylase [GAD65], pancreatic islet b cells [tyrosine phosphatase IA-2], and IA-2b zinc transporter [ZnT8], and/or insulin) in addition to the clinical presentation may help establish the correct diagnosis to distinguish between T1D and T2D in children or adults.22–27”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [27]

    The paper’s introduction (in the Abstract section; page unavailable) identifies insulin, GAD, IA-2 and ZnT8 autoantibodies as markers that precede autoimmune type 1 diabetes. Its Conclusions discuss their use in predicting progression in children, but do not establish that combining them with clinical presentation distinguishes type 1 from type 2 diabetes in children or adults. (LLM, conf=0.83)

    Experimental — accuracy not yet measured
  • The risk of type 1 diabetes increases as the number of relevant autoantibodies detected increases.

    “Indeed, the risk of type 1 diabetes increases as the number of relevant autoantibodies detected increases (55,74,75).”
  • The risk of type 1 diabetes increases as the number of relevant autoantibodies detected increases.

    “Indeed, the risk of type 1 diabetes increases as the number of relevant autoantibodies detected increases (53,74,75).”
  • The presence of GADA, in isolation, is associated with a low risk of development of T1DM.

    “The presence of GADA, in isolation, is associated with a low risk of development of T1DM90.”

    From The epidemiology of type 1 diabetes mellitus in older adults (2025) · cites this paper as [90]

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Research works printed but not linked: 2

  1. [11]11. Knip M, Korhonen S, Kulmala P, et al. Pre- diction of type 1 diabetes in the general popu- lation. Diabetes Care 2010;33:1206-1212
  2. [25]25. Elding Larsson H, Vehik K, Gesualdo P, et al.; TEDDY Study Group. Children followed in the TEDDY study are diagnosed with type 1 diabetes at an early stage of disease. Pediatr Diabetes 2014;15:118-126

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Authors
Steck, A. K., Vehik, K., Bonifacio, E., Lernmark, A., Ziegler, A.-G., Hagopian, W. A., She, J., Simell, O., Akolkar, B., Krischer, J., Schatz, D., Rewers, M. J., & the TEDDY Study Group
Affiliations
  • University of Colorado Anschutz (US)
  • University of South Florida (US)
  • Technische Universität Dresden (DE)
  • Lund University/Clinical Research Centre, Skåne University Hospital, Malmö, Sweden
  • TUM Klinikum (DE)
  • Pacific Northwest Research Institute (US)
  • Medical College of Georgia, Georgia Regents University, Augusta, GA
  • University of Turku (FI)
  • National Institutes of Health (US)
  • University of Florida (US)
Corresponding author
Steck, Andrea K.
Venue
Diabetes Care
Published
2015-02-09
Volume
38
Issue
5
Pages
808-813
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
OpenAlex
W2011929207
Cited by
185
References
39
Citations by year
2026: 12 · 2025: 16 · 2024: 14 · 2023: 20 · 2022: 20 · 2021: 16 · 2020: 11 · 2019: 16 · 2018: 17 · 2017: 17 · 2016: 20 · 2015: 6
FWCI
13.75
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
  • Site cant be reached (submittedVersion)
Funders
  • National Institutes of Health (UL1TR001427, UL1TR000064, UL1TR001082)
  • National Institute of Diabetes and Digestive and Kidney Diseases (UC4DK063861, HHSN267200700014C, U01 DK63865, U01DK063863, UC4DK095300, UC4DK100238, UC4DK063821, R21DK069878, UC4DK063836, U01DK063836, UC4DK63829, UC4DK63836, UC4 DK63865, U01DK63836, U01-DK-63821, U01DK063861, U01DK063865, UC4 DK63821, UC4-DK-63863, U01DK63829, UC4DK95300, UC4-DK-63861, U01DK63861, U01-DK-63790, UC4DK063863, U01 DK63863, UC4DK063829, UC4DK063865, U01DK063821, U01DK063829, U01DK063790, P30DK017047)
  • National Center for Advancing Translational Sciences
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD037800, R21HD050196)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Life Sciences › Immunology and Microbiology › Immunology › T-cell and B-cell Immunology
Keywords
type 1 diabetes, islet autoantibodies, insulin autoantibodies, IA-2 autoantibodies, GAD65 antibodies, disease progression, autoantibody levels, pediatric diabetes, TEDDY study, genetic risk, HLA genotypes, first-degree relatives
MeSH terms
Autoantibodies, Child, Child, Preschool, Diabetes Mellitus, Type 1, Female, Genotype, Glutamate Decarboxylase, HLA-DQ Antigens, HLA-DR Antigens, Humans, Infant, Insulin Antibodies, Islets of Langerhans, Male, Risk Factors, Disease Progression, Receptor-Like Protein Tyrosine Phosphatases, Class 8

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