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Diabetes Metab Res Rev. 2019 Jan 29:e3132. doi: 10.1002/dmrr.3132. [Epub ahead of print]

Antibodies to oxidized insulin improve prediction of type 1 diabetes in children with positive standard islet autoantibodies.

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Department of Medicine, Unit of Endocrinology & Diabetes, Universitá Campus Bio-Medico di Roma, Rome, Italy.
Centre for Biochemical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy.
Division of Pediatrics, Department of Clinical Experimental Medicine, Medical Faculty, Linköping University, Linköping, Sweden.
Centre for Immunobiology, the Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Crown Princess Victoria Children's Hospital, Region Östergötland, Linköping, Sweden.



Antibodies to posttranslationally modified insulin (oxPTM-INS-Ab) are a novel biomarker of type 1 diabetes (T1D). Here, we evaluated whether oxPTM-INS-Ab can improve T1D prediction in children with positive standard islet autoantibodies (AAB).


We evaluated sensitivity, specificity, accuracy, and risk for progression to T1D associated with oxPTM-INS-Ab and the standard islet AAB that include insulin (IAA), GAD (GADA), and tyrosine phosphatase 2 (IA-2A) in a cohort of islet AAB-positive (AAB+ ) children from the general population (median follow-up 8.8 years).


oxPTM-INS-Ab was the most sensitive and specific autoantibody biomarker (74% sensitivity, 91% specificity), followed by IA-2A (71% sensitivity, 91% specificity). GADA and IAA showed lower sensitivity (65% and 50%, respectively) and specificity (66% and 68%, respectively). Accuracy (AUC of ROC) of oxPTM-INS-Ab was higher than GADA and IAA (P = 0.003 and P = 0.017, respectively), and similar to IA-2A (P = 0.896). oxPTM-INS-Ab and IA-2A were more effective than IAA for detecting progr-T1D when used as second-line biomarker in GADA+ children. Risk for diabetes was higher (P = 0.03) among multiple AAB+ who were also oxPTM-INS-Ab+ compared with those who were oxPTM-INS-Ab- . Importantly, when replacing IAA with oxPTM-INS-Ab, diabetes risk increased to 100% in children with oxPTM-INS-Ab+ in combination with GADA+ and IA-2A+ , compared with 84.37% in those with IAA+ , GADA+ , and IA-2A+ (P = 0.04).


Antibodies to oxidized insulin (oxPTM-INS-Ab), compared with IAA which measure autoantibodies to native insulin, improve T1D risk assessment and prediction accuracy in AAB+ children.


biomarker; insulin autoantibodies; posttranslational modifications; prediction; type 1 diabetes


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