PREDICTION OF TYPE-I DIABETES-MELLITUS

Concepts concerning the natural history of Type I diabetes mellitus (IDDM) have radically changed over the last few years. What was considered an acute disease is instead the outcome of a progressive autoimmune process occurring in genetically susceptible individuals. In Islet Cell Antibody body (ICA) positive individuals developing IDDM we do not believe there is a "long latency period" without beta-cell destruction, but rather a long period preceding diabetes of asymptomatic beta-cell destruction. Autoantibodies targeted against all islet cells are currently found years prior to the overt disease and have become useful markers for predicting IDDM. In particular a number of cellular proteins of the neuroendocrine system such as glutamic acid decarboxylase (GAD) and other proteins, such as insulin, are considered autoantigens related to IDDM. The humoral immunity associated with IDDM is heterogeneous and in part immunogenetically determined. For first degree relatives of patients with IDDM it is now possible to predict the development of diabetes and even to estimate the approximate time of onset of the disease. In the near future it will be extremely important to determine which antigens(s) are related to pathogenesis, which will provide reliable markers for prediction, and which antigen specific therapies can be candidates for safe prevention of IDDM.