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Diabetes

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Information

Type I diabetes mellitus (T1DM) is an autoimmune disease which is characterized by the destruction of the insulin-producing beta cells of the pancreatic islets of Langerhans. Genetic predisposition, as well as exogenous factors, e.g. viral infections, diet or obesity are considered to be the causative factors of the disease. Autoantibodies occurring with T1DM are called islet cell antibodies (ICA) and are directed against several antigens of the pancreatic islet cells. The most relevant antibodies are the 65-kDa isoform of the enzyme glutamic acid decarboxylase (GAD65), insulinoma-associated antigen 2 (IA2), zinc transporter 8 (ZnT8) and insulin.

Diagnostic Guidelines

ICA are detected in 70 to 80% of newly diagnosed T1DM cases. The different antibodies of this group usually develop subsequently, not simultaneously. The development of ICA precedes manifest T1DM by months or even years. In 90% of patients, one or more ICA can be detected even before the onset of clinical symptoms. The higher the number of different ICA in one person, the higher is their risk of developing T1DM.

The autoimmune reaction usually sets in years before the hyperglycemic symptoms of T1DM. The destructive process, i.e. insulitis, is characterized by infiltrates from immune cells in the pancreatic islets. T1DM becomes manifest when the major part of beta cells has been destroyed and the blood sugar level is no longer regulated. This development mostly takes place during childhood or adolescence. T1DM is the most severe form of diabetes and leads to lifelong dependence on insulin injections. 5 to 10% of all diabetes cases are of type I. The worldwide incidence of T1DM increases by 3 to 5% each year.

Autoantibodies against insulin (IAA) are often the first autoantibodies to occur in T1DM. They can be found in almost all prediabetic persons; their prevalence decreases with increasing age of the patients. IAA can be detected in 80% of patients under ten years and around 60% of patients between 10 and 20 years of age. Children under 5 years present the highest IAA titers.

Autoantibodies against GAD65 (GADA) can be found in around 70% of patients before onset of T1DM and in 70 to 90% of T1DM patients at the beginning of the disease. GADA are the most sensitive markers for T1DM occurring in the adult age, as well as for LADA (latent autoimmune diabetes in adulthood). LADA is present in 3 to 12% of patients with phenotypical type II diabetes mellitus which is characterized by insulin resistance and disturbed insulin secretion from the beta cells. 90% of LADA patients present GADA and most of them are positive for GADA already several years before the diagnosis.

Autoantibodies against IA2 can be found in 50 to 70% of children and adolescents, and in 30 to 50% of adults with newly diagnosed T1DM. In around half of the patients, IA2A are detected even prior to the disease manifestation. IA2A are highly specific for T1DM.

Anti-ZnT8 antibodies are detectable in the serum of many children with prediabetes. They persist until manifestation of T1DM. The anti-ZnT8 level drops rapidly over the first years following disease onset. Anti-ZnT8 antibodies are also detected in nearly 25% of LADA patients. As with other autoantibodies, their presence can predict the transition to the insulin-dependent stage in LADA patients.
Combined determination of antibodies against GAD65, IA2, ZnT8 and insulin enables the identification of T1DM already at disease onset in 98% of cases.

Diabetes products

For Research Use Only. Not For Use In Diagnostic Procedures.
The individual product regulatory statements may vary, please refer to the instructions for use for more information.

wdt_ID Method Parameter Substrate Species/ Antigen
555 IFA islet cells antibodies (PM) EUROPattern
pancreas islets
1 BIOCHIP per field:
pancreas
monkey
556 IFA pancreas islets pancreas monkey
557 IFA pancreas islets pancreas islets
(three 1 x 1 mm BIOCHIPs
per field)
monkey
558 IFA pancreas islets, GAD
brain: grey and white matter,
Purkinje cell cytoplasm (Yo),
Hu and Ri antigen
pancreas
cerebellum
(2 BIOCHIPs per field)
monkey
monkey
559 IFA antibodies against pancreas islets
(islet cell ab control)
560 IFA antibodies against pancreas islets
control with JDF units
561 IFA antibodies against glutamic acid decarboxylase
(GAD ab control)
562 ELISA GAD antigen-coated
microplate wells
recombinant
glutamic acid decarboxylase (GAD65)
563 ELISA GAD/IA2 Pool antigen-coated
microplate wells
microplate wells
recombinant
glutamic acid decarboxylase (GAD65)/
tyrosine phosphatase
564 IFA glutamic acid decarboxylase (GAD) 65 kDa
(stiff-person syndrome)
transfected cells
control transfection
(2 BIOCHIPs per field)
EU 90
EU 90
565 ELISA IA2 antigen-coated
microplate wells
recombinant
tyrosine phosphatase
566 RIA insulin
precipitation
labelled antigen synthetic product,
human
567 ELISA zinc transporter 8 antigen-coated
microplate wells
Method Parameter Substrate Species/ Antigen
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