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

Research output: Contribution to journalArticle

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 3months 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 1month of diabetes onset, then at 3, 6, and 12months, 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%, 51mmol/mol) than control (10.5%, 91mmol/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 12months following diabetes onset and appear to represent a shift in the disease process of about 6months. 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.

Details

Authors
  • Andrea K Steck
  • Helena Elding Larsson
  • Xiang Liu
  • Riitta Veijola
  • Jorma Toppari
  • William A. Hagopian
  • Michael J. Haller
  • Simi Ahmed
  • Beena Akolkar
  • Åke Lernmark
  • Marian J. Rewers
  • Jeffrey P Krischer
Organisations
External organisations
  • University of Colorado
  • Skåne University Hospital
  • University of South Florida
  • University of Oulu
  • Turku University Hospital
  • Pacific Northwest Diabetes Research Institute
  • Juvenile Diabetes Research Foundation
  • National Institute of Diabetes and Digestive and Kidney Diseases
  • University of Florida
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Endocrinology and Diabetes
  • Pediatrics

Keywords

  • HbA1c, Pediatric diabetes, Preservation of C-peptide, Prospective study, Type 1 diabetes
Original languageEnglish
Pages (from-to)794-802
JournalPediatric Diabetes
Volume18
Issue number8
Early online date2017
Publication statusPublished - 2017
Publication categoryResearch
Peer-reviewedYes