Mario Cotellessa

Beta-cell autoantibodies and diabetes mellitus family history in cystic fibrosis

OBJECTIVE To verify whether autoimmunity against beta-cells and family history of type 1 and/or type 2 diabetes mellitus (DM) play a role in the pathogenesis of cystic fibrosis (CF)-related diabetes mellitus (CFRD). PATIENTS AND METHODS The prevalence of beta-cell autoantibodies (GADA and IA-2A) was investigated in a group of patients with CF compared with patients with type 1 DM (DM1) and controls. Family history of DM1 and/or DM2 was investigated among patients with CF. RESULTS Frequency of beta-cell autoantibodies was significantly lower (p = 0.0001) in patients with CF with CFRD (IA-2A: 0%; GADA 12.5%) than in patients with DM1 (64.1% vs 52.8%, respectively) and it did not differ from the frequency in patients with CF without CFRD. Prevalence of family history for DM1 or DM2 was not significantly higher in CF patients with CFRD than in CF patients without CFRD. CONCLUSIONS The investigated factors did not show correlation with the pathogenesis of CFRD.

Incidence of Type I Diabetes in the Liguria Region, Italy: Results of a prospective study in a 0- to 14-year age-group

OBJECTIVE To assess updated incidence of insulin-dependent diabetes mellitus (IDDM) in 0- to 14-year-old children in Liguria, a northwest region of Italy. RESEARCH DESIGN AND METHODS Incident cases were recorded prospectively from 1987 to 1991. Incidence rates (IRs) were directly standardized on the basis of the 1990 world population. The independent effect of age, sex, residence, and calendar year was estimated with a Poisson regression model. The degree of ascertainment was calculated in accordance with the capture/recapture method. RESULTS During 5 full calendar years, 117 new cases of IDDM in children were diagnosed in Liguria. The standardized IR over the 5-year period was 11.72 cases·100,000−1·year−1. The sex-specific IR among males and females was 11.45 and 12.01, respectively. The age-specific IR was higher in the 5–9 age-group. CONCLUSIONS The IR of IDDM in Liguria is among the highest in southern Europe and approaches that of northern European countries. In particular, it is much higher than those reported in the surrounding Italian regions, except for Sardinia. Therefore, the geographical distribution of IDDM does not seem to reflect the simple north-south gradient reported in several previous studies.

Autoimmune Thyroiditis In IDDM Patients

We have read with interest the article by McKenna et al. in the July 1990 issue of Diabetes Care(1). We report here the results of a study that we recently conducted, reaching conclusions similar to those contained in the article by McKenna et al. Thyroid autoantibodies were detected by indirect immunofluorescence on rat tissue sections. Among the patients who were autoantibody positive, 34 subjects showed a normal thyroid function (triiodothyronine and thyroxine [T3 and T4], thyroidstimulating hormone [TSH] in the normal range at baseline, normal TSH response to thyrotropin-releasing hormone [TRH] stimulus). Four patients had compensed hypothyroidism (high TSH levels both at baseline and after TRH stimulus, with normal T3 and T4 levels). In the latter group, we observed a 9-yr-old girl with autoantibody positivity (thyroglobulin antigen [TGA] and microsomal antigen [MCA]) who, within 5 mo from the detection of thyroid autoantibodies, developed thyroid dysfunction that progressed to overt hypothyroidism and goiter (Table 1). Based on our experience, we suggest that patients with insulin-dependent diabetes mellitus (IDDM) with thyroid autoantibody positivity undergo frequent assessments of thyroid function. IDDM patients should be evaluated for serum TSH levels at least at 6-mo intervals, considering their high risk to develop clinical hypothyroidism.