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Pediatr Diabetes. 2013 Aug;14(5):333-40. doi: 10.1111/pedi.12022. Epub 2013 Mar 5.

Types of pediatric diabetes mellitus defined by anti-islet autoimmunity and random C-peptide at diagnosis.

Author information

1
Department of Pediatrics, Section of Diabetes and Endocrinology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA. redondo@bcm.edu

Abstract

OBJECTIVE:

To test the hypothesis that anti-islet autoantibody expression and random serum C-peptide obtained at diagnosis define phenotypes of pediatric diabetes with distinct clinical features.

SUBJECTS:

We analyzed 607 children aged <19 yr consecutively diagnosed with diabetes after exclusion of 13% of cases with secondary diabetes (e.g., cystic fibrosis related, steroid induced) and 7.3% of cases lacking measurement of C-peptide and/or autoantibodies.

METHODS:

Autoantibody positivity (A+) was defined as ≥ 1 positive out of GAD65, insulin, and ICA512 antibodies. Preserved beta-cell function (β+) was defined as random serum C-peptide at diagnosis ≥ 0.6 ng/mL. Body mass index (BMI) was measured at median 1.2 months after diagnosis. Characteristics at diagnosis and 2 yr (range 18-30 months) after diagnosis were compared among groups.

RESULTS:

Autoantibody expression and C-peptide at diagnosis defined the following groups: A+β- (52.1% of the children), A+β+ (32.8%), A-β+ (12.5%), and A-β- (2.6%). These four groups differed in gender, race/ethnicity, and clinical characteristics at diagnosis [i.e., age, pubertal development, obesity/overweight, diabetic ketoacidosis, glycemia, and hemoglobin A1c (HbA1c)] and at 2 yr (i.e., clinical diagnosis, treatment, and HbA1c) (all p < 0.0001). Among all β+ children, C-peptide >2 ng/mL was associated with lower HbA1c at onset (p = 0.0001) and, in the A+β+ subgroup, with higher frequency of achieving HbA1c < 7% at 2 yr (p = 0.03). All three patients (0.7% of total) with monogenic diabetes (maturity onset diabetes of the young, MODY) were A-β+ with C-peptide between 0.6 and 2 ng/mL.

CONCLUSIONS:

Anti-islet autoantibodies status and serum random C-peptide at diagnosis define four distinct phenotypes of pediatric diabetes with prognostic value.

KEYWORDS:

C-peptide; Classification; autoantibodies; children; diabetes

PMID:
23458188
DOI:
10.1111/pedi.12022
[Indexed for MEDLINE]

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