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Pediatr Diabetes. 2017 Dec;18(8):794-802. doi: 10.1111/pedi.12485. Epub 2017 Jan 27.

Residual beta-cell function in diabetes children followed and diagnosed in the TEDDY study compared to community controls.

Author information

1
Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, Colorado.
2
Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
3
Health Informatics Institute, University of South Florida, Tampa, Florida.
4
Department of Pediatrics, PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
5
Turku Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland.
6
Department of Pediatrics, Turku University Hospital, Turku, Finland.
7
Pacific Northwest Diabetes Research Institute, University of Washington, Seattle, WA.
8
Department of Pediatrics, University of Florida, Gainesville, Florida.
9
Immunology of T1D, JDRF International, New York, New York.
10
Division of Diabetes, Endocrinology & Metabolism, National Institute of Diabetes, Digestive, & Kidney Diseases, National Institutes of Health, Bethesda, Maryland.

Abstract

OBJECTIVE:

To explore whether children diagnosed with type 1 diabetes during islet autoantibody surveillance through The Environmental Determinants of Diabetes in the Young (TEDDY) study retain greater islet function than children diagnosed through the community.

METHODS:

TEDDY children identified at birth with high-risk human leukocyte antigen and followed every 3 months until diabetes diagnosis were compared to age-matched children diagnosed with diabetes in the community. Both participated in long-term follow up after diagnosis. Hemoglobin A1c (HbA1c) and mixed meal tolerance test were performed within 1 month of diabetes onset, then at 3, 6, and 12 months, and biannually thereafter.

RESULTS:

Comparison of 43 TEDDY and 43 paired control children showed that TEDDY children often had no symptoms (58%) at diagnosis and none had diabetic ketoacidosis (DKA) compared with 98% with diabetes symptoms and 14% DKA in the controls (P < 0.001 and P = 0.03, respectively). At diagnosis, mean HbA1c was lower in TEDDY (6.8%, 51 mmol/mol) than control (10.5%, 91 mmol/mol) children (P < 0.0001). TEDDY children had significantly higher area under the curve and peak C-peptide values than the community controls throughout the first year postdiagnosis. Total insulin dose and insulin dose-adjusted A1c were lower throughout the first year postdiagnosis for TEDDY compared with control children.

CONCLUSIONS:

Higher C-peptide levels in TEDDY vs community-diagnosed children persist for at least 12 months following diabetes onset and appear to represent a shift in the disease process of about 6 months. Symptom-free diagnosis, reduction of DKA, and the potential for immune intervention with increased baseline C-peptide may portend additional long-term benefits of early diagnosis.

KEYWORDS:

HbA1c ; pediatric diabetes; preservation of C-peptide; prospective study; type 1 diabetes

PMID:
28127835
PMCID:
PMC5529265
DOI:
10.1111/pedi.12485
[Indexed for MEDLINE]
Free PMC Article

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