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BMJ Open. 2018 Apr 4;8(4):e020904. doi: 10.1136/bmjopen-2017-020904.

Relationship between islet autoantibody status and the clinical characteristics of children and adults with incident type 1 diabetes in a UK cohort.

Collaborators (295)

V A, K A, J A, K A, M A, Z A, R A, F A, A A, K A, B A, C A, R A, B A, S A, T A, O A, R B, S B, E B, A B, K B, M B, D B, A B, K B, S B, S B, R B, P B, B B, S B, A B, R B, E B, C B, N B, A B, D B, J B, N C, G C, F C, P C, D C, S C, S C, J C, A C, T C, J C, P C, H C, R C, J C, P C, P C, J C, P C, S C, C C, D C, S C, M C, M C, C D, K D, U D, J D, M D, R D, P D, P S, A D, A D, P D, A D, I D, I D, K D, S D, A D, S D, K E, J E, C E, M E, A E, S ER, M E, M E, B F, D F, B F, D G, T G, J G, J G, M G, L G, A G, S G, P G, K G, J G, A G, S G, E G, J HS, P H, T H, F H, P H, M H, K H, B H, A H, J H, A H, H H, S H, F H, G H, H H, S H, Z H, S H, O I, I I, S I, N I, B I, A J, A J, N J, P J, K J, R J, S J, F J, J J, S J, S K, N K, R K, S K, P K, M K, B K, K K, K L, A L, J L, K L, D L, A L, G L, A M, K M, R M, N M, P M, G M, A M, V M, A M, E M, K M, M M, F M, J M, A M, C M, G M, R M, A M, A M, C M, N MI, M M, N M, S M, K M, D N, S N, P N, A N, Y N, R N, M N, U N, K N, I O, R O, P O, N O, B O, O O, L O, C O, K O, N P, B P, T P, N P, K P, K P, P P, J PS, M P, A P, A P, B P, R P, N P, N P, H P, T P, V P, R P, R P, T R, P R, S R, A R, T R, S R, S R, G R, F R, S R, M R, E R, M R, D RJ, M RT, M R, M S, J S, S S, V S, P S, H S, R S, J S, I S, D S, R S, S S, S S, G S, H S, B S, P S, D S, J S, P S, H S, B S, R S, H S, J S, A S, P S, S T, K T, A T, N T, B T, J V, U V, S V, A V, K V, J V, F WL, M W, D W, W W, A W, J W, J W, K W, N W, P W, D W, N W, J W, P W, S W, K W, N W, C AY, S Y, S ZV.

Author information

1
Department of Medicine, Imperial College London, London, UK.
2
School of Clinical Sciences, University of Bristol, Bristol, UK.
3
Department of Paediatrics, University of Cambridge, Cambridge, UK.
4
School of Medicine, Cardiff University, Cardiff, UK.
5
Department of Immunobiology, King's College London, London, UK.

Abstract

OBJECTIVES:

To describe the characteristics of children and adults with incident type 1 diabetes in contemporary, multiethnic UK, focusing on differences between the islet autoantibody negative and positive.

DESIGN:

Observational cohort study.

SETTING:

146 mainly secondary care centres across England and Wales.

PARTICIPANTS:

3312 people aged ≥5 years were recruited within 6 months of a clinical diagnosis of type 1 diabetes via the National Institute for Health Research Clinical Research Network. 3021 were of white European ethnicity and 291 (9%) were non-white. There was a small male predominance (57%). Young people <17 years comprised 59%.

MAIN OUTCOME MEASURES:

Autoantibody status and characteristics at presentation.

RESULTS:

The majority presented with classical osmotic symptoms, weight loss and fatigue. Ketoacidosis was common (42%), especially in adults, and irrespective of ethnicity. 35% were overweight or obese. Of the 1778 participants who donated a blood sample, 85% were positive for one or more autoantibodies against glutamate decarboxylase, islet antigen-2 and zinc transporter 8. Presenting symptoms were similar in the autoantibody-positive and autoantibody-negative participants, as was the frequency of ketoacidosis (43%vs40%, P=0.3). Autoantibody positivity was less common with increasing age (P=0.0001), in males compared with females (82%vs90%, P<0.0001) and in people of non-white compared with white ethnicity (73%vs86%, P<0.0001). Body mass index was higher in autoantibody-negative adults than autoantibody-positive adults (median, IQR 25.5, 23.1-29.2vs23.9, 21.4-26.7 kg/m2; P=0.0001). Autoantibody-negative participants were more likely to have a parent with diabetes (28%vs16%, P<0.0001) and less likely to have another autoimmune disease (4%vs8%, P=0.01).

CONCLUSIONS:

Most people assigned a diagnosis of type 1 diabetes presented with classical clinical features and islet autoantibodies. Although indistinguishable at an individual level, autoantibody-negative participants as a group demonstrated features more typically associated with other diabetes subtypes.

TRIAL REGISTRATION NUMBER:

ISRCTN66496918; Pre-results.

KEYWORDS:

epidemiology; general diabetes; immunology; paediatric endocrinology

PMID:
29622578
PMCID:
PMC5893930
DOI:
10.1136/bmjopen-2017-020904
[Indexed for MEDLINE]
Free PMC Article

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