Heterogeneity of DKA Incidence and Age-Specific Clinical Characteristics in Children Diagnosed With Type 1 Diabetes in the TEDDY Study

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Heterogeneity of DKA Incidence and Age-Specific Clinical Characteristics in Children Diagnosed With Type 1 Diabetes in the TEDDY Study

Jacobsen, Laura M. (author): University of Florida

Vehik, Kendra (author): University of South Florida

Veijola, Riitta (author): Oulu University Hospital,University of Oulu

Warncke, Katharina (author): Helmholtz Zentrum München

Toppari, Jorma (author): University of Turku,Turku University Hospital

Steck, Andrea K. (author): University of Colorado School of Medicine

Gesualdo, Patricia (author): University of Colorado School of Medicine

Akolkar, Beena (author): National Institute of Diabetes and Digestive and Kidney Diseases

Lundgren, Markus (author): Lund University,Lunds universitet,Pediatrisk endokrinologi,Forskargrupper vid Lunds universitet,Paediatric Endocrinology,Lund University Research Groups,Skåne University Hospital

Hagopian, William A. (author): Pacific Northwest Research Institute

She, Jin Xiong (author): Medical College of Georgia

Rewers, Marian (author): University of Colorado School of Medicine

Ziegler, Anette G. (author): University of Oulu,Oulu University Hospital

Krischer, Jeffrey P. (author): University of South Florida

Larsson, Helena Elding (author): Lund University,Lunds universitet,Pediatrisk endokrinologi,Forskargrupper vid Lunds universitet,Paediatric Endocrinology,Lund University Research Groups,Skåne University Hospital

Haller, Michael J. (author): University of Florida

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2022-01-18
2022
English 10 s.
In: Diabetes Care. - : American Diabetes Association. - 0149-5992. ; 45:3, s. 624-633

Related links:: http://dx.doi.org/10...; show more...; https://diabetesjour...; https://lup.lub.lu.s...; https://doi.org/10.2...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

OBJECTIVE The Environmental Determinants of Diabetes in the Young (TEDDY) study is uniquely capable of investigating age-specific differences associated with type 1 diabetes. Because age is a primary driver of heterogeneity in type 1 diabetes, we sought to characterize by age metabolic derangements prior to diagnosis and clinical features associated with diabetic ketoacidosis (DKA). RESEARCH DESIGN AND METHODS The 379 TEDDY children who developed type 1 diabetes were grouped by age at onset (0–4, 5–9, and 10–14 years; n = 142, 151, and 86, respectively) with com-parisons of autoantibody profiles, HLAs, family history of diabetes, presence of DKA, symptomatology at onset, and adherence to TEDDY protocol. Time-varying analysis compared those with oral glucose tolerance test data with TEDDY children who did not progress to diabetes. RESULTS Increasing fasting glucose (hazard ratio [HR] 1.09 [95% CI 1.04–1.14]; P = 0.0003), stimulated glucose (HR 1.50 [1.42–1.59]; P < 0.0001), fasting insulin (HR 0.89 [0.83–0.95]; P = 0.0009), and glucose-to-insulin ratio (HR 1.29 [1.16–1.43]; P < 0.0001) were associated with risk of progression to type 1 diabetes. Younger children had fewer autoantibodies with more symptoms at diagnosis. Twenty-three children (6.1%) had DKA at onset, only 1 (0.97%) of 103 with and 22 (8.0%) of 276 children without a first-degree relative (FDR) with type 1 diabetes (P = 0.008). Children with DKA were more likely to be nonadherent to study protocol (P = 0.047), with longer duration between their last TEDDY evaluation and diagnosis (median 10.2 vs. 2.0 months without DKA; P < 0.001). CONCLUSIONS DKA at onset in TEDDY is uncommon, especially for FDRs. For those without familial risk, metabolic monitoring continues to provide a primary benefit of reduced DKA but requires regular follow-up. Clinical and laboratory features vary by age at onset, adding to the heterogeneity of type 1 diabetes.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)

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By the author/editor: Jacobsen, Laura ...; Vehik, Kendra; Veijola, Riitta; Warncke, Kathari ...; Toppari, Jorma; Steck, Andrea K.; show more...; Gesualdo, Patric ...; Akolkar, Beena; Lundgren, Markus; Hagopian, Willia ...; She, Jin Xiong; Rewers, Marian; Ziegler, Anette ...; Krischer, Jeffre ...; Larsson, Helena ...; Haller, Michael ...; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Endocrinology an ...

Articles in the publication: Diabetes Care

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