Published online May 15, 2024. doi: 10.4239/wjd.v15.i5.935
Peer-review started: January 27, 2024
First decision: February 5, 2024
Revised: February 7, 2024
Accepted: March 11, 2024
Article in press: March 11, 2024
Published online: May 15, 2024
Processing time: 104 Days and 10.4 Hours
Anti-islet autoantibodies serve as valuable markers for predicting and diagnosing type 1 diabetes (T1D). It is well-established that 20%-30% of T1D patients also have autoimmune thyroid disease (AITD). However, data regarding anti-islet autoantibodies in AITD patients remain limited. The 3 Screen Islet Cell Autoantibody enzyme-linked immunosorbent assay (3 Screen ICA ELISA) is a multiplex anti-islet autoantibody assay capable of simultaneously measuring autoantibodies against glutamic acid decarboxylase (GADA), insulinoma-associated antigen-2 (IA-2A) and zinc transporter 8 (ZnT8A).
The motivation behind this research is to investigate the frequency and titer of anti-islet autoantibodies in patients with AITD, aiming to facilitate the staging and early diagnosis of T1D.
The primary objectives of this research are as follows: (1) To determine the frequency and titer of anti-islet autoantibodies in AITD patients using the 3 Screen ICA ELISA method; and (2) To compare these findings to those of individual autoantibodies, particularly GADA, which are commonly the first markers assessed in general clinical practice.
The research methodology involved the following steps: (1) Selection of a cohort of 495 patients with AITD, categorized into three groups: AITD with T1D (n = 18), AITD with phenotypic type 2 diabetes (T2D) (n = 81), and AITD without diabetes (n = 396); and (2) Examination of the frequency of anti-islet autoantibodies, including 3 Screen ICA, GADA, IA-2A, and ZnT8A using the bridging-type ELISA method.
The key findings of the study include: (1) Frequencies of 3 Screen ICA in AITD patients with T1D, AITD patients with T2D, and those without diabetes being 88.9%, 6.2%, and 5.1%, with no significant difference between the latter two groups; (2) The frequency of 3 Screen ICA was 11.1% higher in AITD patients with T1D, 1.3% higher in AITD patients with T2D, and 1.1% higher in those without diabetes compared to GADA, respectively, and a significant proportion of 3 Screen ICA-positive patients were negative for GADA (12.5%, 20.0%, and 20.0%); and (3) There was no significant difference in 3 Screen ICA titers between AITD patients with T1D and those without diabetes (436.8 ± 66.4 vs 308.1 ± 66.4 index).
This study concludes that some AITD patients without diabetes exhibit comparable 3 Screen ICA titers to those observed in AITD patients with T1D. These findings suggest that 3 Screen ICA is outperforms GADA in identifying latent anti-islet autoantibody-positive individuals within the AITD patient population.
To further investigate the predictive potential of 3 Screen ICA for the development of T1D, it is recommended that prospective studies be conducted in the future. These studies should focus on tracking changes in glucose tolerance and endogenous insulin secretion in AITD patients with T2D and those without diabetes. Such investigations will provide valuable insights into the clinical utility of 3 Screen ICA in identifying individuals at risk of transitioning to T1D.