OBJECTIVE
Recent joint American Diabetes Association and European Association for the Study of Diabetes guidelines recommend routine islet autoantibody testing in all adults newly diagnosed with type 1 diabetes. We aimed to assess the impact of routine islet autoantibody testing in this population.
RESEARCH DESIGN AND METHODS
We prospectively assessed the relationship between islet autoantibody status (GADA, IA-2A, and ZNT8A), clinical and genetic characteristics, and progression (annual change in urine C-peptide–to–creatinine ratio [UCPCR]) in 722 adults (≥18 years old at diagnosis) with clinically diagnosed type 1 diabetes and diabetes duration <12 months. We also evaluated changes in treatment and glycemia over 2 years after informing participants and their clinicians of autoantibody results.
RESULTS
Of 722 participants diagnosed with type 1 diabetes, 24.8% (179) were autoantibody negative. This group had genetic and C-peptide characteristics suggestive of a high prevalence of nonautoimmune diabetes: lower mean type 1 diabetes genetic risk score (islet autoantibody negative vs. positive: 10.85 vs. 13.09 [P < 0.001] [type 2 diabetes 10.12]) and lower annual change in C-peptide (UCPCR), −24% vs. −43% (P < 0.001).
After median 24 months of follow-up, treatment change occurred in 36.6% (60 of 164) of autoantibody-negative participants: 22.6% (37 of 164) discontinued insulin, with HbA1c similar to that of participants continuing insulin (57.5 vs. 60.8 mmol/mol [7.4 vs. 7.7%], P = 0.4), and 14.0% (23 of 164) added adjuvant agents to insulin.
CONCLUSIONS
In adult-onset clinically diagnosed type 1 diabetes, negative islet autoantibodies should prompt careful consideration of other diabetes subtypes. When routinely measured, negative antibodies are associated with successful insulin cessation. These findings support recent recommendations for routine islet autoantibody assessment in adult-onset type 1 diabetes.
The tool, Elevating Instruction: A Planning Tool, was designed to aid teachers in improving literacy instruction to best meet the academic needs of all students, including advanced readers in the primary classroom. It is crucial for teachers to elevate reading practices for advanced readers during the time when young learners are developing skills to be lifelong readers. Teachers can do this by promoting authentic choice, encouraging student agency and ownership, supporting meaningful peer interactions, and collecting and using formative data. To this end, the authors address these four instructional components within the scope of a literacy block in an elementary classroom using an easy-to-access and easy-to-implement planning tool, which teachers can use to enhance instruction for all students. The use of this tool is depicted by a classroom teacher working with a gifted resource teacher (GRT), demonstrating how the tool can be used to support teachers as they work to improve and elevate literacy instruction.
College's reply: I am grateful to Dr Veasey (2000, this issue) for raising this matter. The College has to balance its obligations to members with its main purpose of raising standards in psychiatry. Sometimes this is a difficult balancing act. Members will be aware that Council has recently agreed to establish an External Clinical Advisory Service. This will offer expert external advice to NHS trusts on any psychiatric service which is not functioning effectively. Further details of the service, which will be of assistance to College members as well as protecting patients, will appear on the College's website. Dr Peter Snowden has been appointed Director of this service. You will be glad to know that the College has made a robust response to the recent Tilt Report and copies of this response will also be available on the College's website in the near future. VEASEY, D. A. (2000) Further comments on inquiry panels (letter). Psychiatric Bulletin, 24, 393.
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