Miller RG, et al. - Researchers assessed a childhood-onset (age < 17 years), long-duration (≥ 32 years) type 1 diabetes cohort for the correlation between islet autoantibody positivity and clinical characteristics, residual β-cell function (C-peptide) and prevalence of complications. The assessment of serum samples from participants who attended the 2011–2013 Pittsburgh Epidemiology of Diabetes Complications study follow-up examination (n = 177, mean age 51 years, diabetes duration 43 years) revealed the following prevalences of islet autoantibodies: glutamic acid decarboxylase, 32%; insulinoma-associated protein 2, 22%; and zinc transporter-8, 4%. Observations revealed correlation of glutamic acid decarboxylase antibody positivity with lower HbA1c, correlation of insulinoma-associated protein 2 antibody positivity with a lower prevalence of severe hypoglycaemic episodes and both distal and autonomic neuropathy, and correlation of zinc transporter-8 antibody positivity with higher total and LDL cholesterol. This study thus suggests a strong correlation between islet autoantibody positivity and older age at type 1 diabetes onset thereby strengthening the hypothesis that those with older age at onset exhibit a less aggressive, and thus more persistent, immune process. This observation implies the possibility of long-term persistence of heterogeneity in the underlying autoimmune process.