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Heterogeneity of DK...
Heterogeneity of DKA Incidence and Age-Specific Clinical Characteristics in Children Diagnosed With Type 1 Diabetes in the TEDDY Study
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- Jacobsen, Laura M. (author)
- University of Florida
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- Vehik, Kendra (author)
- University of South Florida
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- Veijola, Riitta (author)
- Oulu University Hospital,University of Oulu
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- Warncke, Katharina (author)
- Helmholtz Zentrum München
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- Toppari, Jorma (author)
- University of Turku,Turku University Hospital
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- Steck, Andrea K. (author)
- University of Colorado School of Medicine
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- Gesualdo, Patricia (author)
- University of Colorado School of Medicine
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- Akolkar, Beena (author)
- National Institute of Diabetes and Digestive and Kidney Diseases
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- Lundgren, Markus (author)
- Lund University,Lunds universitet,Pediatrisk endokrinologi,Forskargrupper vid Lunds universitet,Paediatric Endocrinology,Lund University Research Groups,Skåne University Hospital
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- Hagopian, William A. (author)
- Pacific Northwest Research Institute
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- She, Jin Xiong (author)
- Medical College of Georgia
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- Rewers, Marian (author)
- University of Colorado School of Medicine
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- Ziegler, Anette G. (author)
- University of Oulu,Oulu University Hospital
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- Krischer, Jeffrey P. (author)
- University of South Florida
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- Larsson, Helena Elding (author)
- Lund University,Lunds universitet,Pediatrisk endokrinologi,Forskargrupper vid Lunds universitet,Paediatric Endocrinology,Lund University Research Groups,Skåne University Hospital
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- Haller, Michael J. (author)
- University of Florida
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(creator_code:org_t)
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- 2022-01-18
- 2022
- English 10 s.
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In: Diabetes Care. - : American Diabetes Association. - 0149-5992. ; 45:3, s. 624-633
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Abstract
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- 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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- art (subject category)
- ref (subject category)
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- By the author/editor
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Jacobsen, Laura ...
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Vehik, Kendra
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Veijola, Riitta
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Warncke, Kathari ...
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Toppari, Jorma
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Steck, Andrea K.
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show more...
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Gesualdo, Patric ...
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Akolkar, Beena
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Lundgren, Markus
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Hagopian, Willia ...
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She, Jin Xiong
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Rewers, Marian
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Ziegler, Anette ...
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Krischer, Jeffre ...
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Larsson, Helena ...
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Haller, Michael ...
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Endocrinology an ...
- Articles in the publication
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Diabetes Care
- By the university
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Lund University