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

Steck, Andrea K; Larsson, Helena Elding LU ; Liu, Xiang; Veijola, Riitta; Toppari, Jorma; Hagopian, William A.; Haller, Michael J.; Ahmed, Simi; Akolkar, Beena and Lernmark, Åke LU , et al. (2017) In Pediatric Diabetes 18(8). p.794-802
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... (More)

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.

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Contribution to journal
publication status
published
subject
keywords
HbA1c, Pediatric diabetes, Preservation of C-peptide, Prospective study, Type 1 diabetes
in
Pediatric Diabetes
volume
18
issue
8
pages
794 - 802
publisher
Wiley-Blackwell
external identifiers
  • scopus:85011604859
  • pmid:28127835
  • wos:000415012600017
ISSN
1399-543X
DOI
10.1111/pedi.12485
language
English
LU publication?
yes
id
86575e08-7ab9-43c6-acf7-b2fc757b884a
date added to LUP
2017-02-16 16:46:06
date last changed
2018-01-16 13:23:44
@article{86575e08-7ab9-43c6-acf7-b2fc757b884a,
  abstract     = {<p>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&lt;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&lt;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.</p>},
  author       = {Steck, Andrea K and Larsson, Helena Elding and Liu, Xiang and Veijola, Riitta and Toppari, Jorma and Hagopian, William A. and Haller, Michael J. and Ahmed, Simi and Akolkar, Beena and Lernmark, Åke and Rewers, Marian J. and Krischer, Jeffrey P},
  issn         = {1399-543X},
  keyword      = {HbA1c,Pediatric diabetes,Preservation of C-peptide,Prospective study,Type 1 diabetes},
  language     = {eng},
  number       = {8},
  pages        = {794--802},
  publisher    = {Wiley-Blackwell},
  series       = {Pediatric Diabetes},
  title        = {Residual beta-cell function in diabetes children followed and diagnosed in the TEDDY study compared to community controls},
  url          = {http://dx.doi.org/10.1111/pedi.12485},
  volume       = {18},
  year         = {2017},
}