Types of pediatric diabetes mellitus defined by anti‐islet autoimmunity and random C‐peptide at diagnosis. Issue 5 (5th March 2013)

• Record Type: Journal Article
• Authors: Redondo, Maria J; Rodriguez, Luisa M; Escalante, Mirna; Smith, E O'Brian; Balasubramanyam, Ashok; Haymond, Morey W
• Is Part Of: Pediatric diabetes. Volume 14:Issue 5(2013)
• Page Start: 333
• Page End: 340
• Publication Date: 2013-03-05
• Subjects: Diabetes in children -- Periodicals; 616.462
• DOI: 10.1111/pedi.12022
• Languages: English
• ISSNs: 1399-543X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="pedi12022-sec-0001" sec-type="section"> <title>Objective</title> <p>To test the hypothesis that anti‐islet autoantibody expression and random serum C‐peptide obtained at diagnosis define phenotypes of pediatric diabetes with distinct clinical features.</p> </sec> <sec id="pedi12022-sec-0002" sec-type="section"> <title>Subjects</title> <p>We analyzed 607 children aged <19 yr consecutively diagnosed with diabetes after exclusion of 13% of cases with secondary diabetes (e.g., cystic fibrosis related, steroid induced) and 7.3% of cases lacking measurement of C‐peptide and/or autoantibodies.</p> </sec> <sec id="pedi12022-sec-0003" sec-type="section"> <title>Methods</title> <p>Autoantibody positivity (A+) was defined as ≥1 positive out of GAD65, insulin, and ICA512 antibodies. Preserved beta‐cell function (β+) was defined as random serum C‐peptide at diagnosis ≥ 0.6 ng/mL. Body mass index (BMI) was measured at median 1.2 months after diagnosis. Characteristics at diagnosis and 2 yr (range 18–30 months) after diagnosis were compared among groups.</p> </sec> <sec id="pedi12022-sec-0004" sec-type="section"> <title>Results</title> <p>Autoantibody expression and C‐peptide at diagnosis defined the following groups: A+β− (52.1% of the children), A+β+ (32.8%), A−β+ (12.5%), and A−β− (2.6%). These four groups differed in gender, race/ethnicity, and clinical characteristics at diagnosis [i.e., age, pubertal development, obesity/overweight, diabetic ketoacidosis, glycemia, and hemoglobin A1c (HbA1c)] and at 2 yr (i.e., clinical diagnosis, treatment, and HbA1c) (all p < 0.0001). Among all β+ children, C‐peptide >2 ng/mL was associated with lower HbA1c at onset (p = 0.0001) and, in the A+β+ subgroup, with higher frequency of achieving HbA1c < 7% at 2 yr (p = 0.03). All three patients (0.7% of total) with monogenic diabetes (maturity onset diabetes of the young, MODY) were A−β+ with C‐peptide between 0.6 and 2 ng/mL.</p> </sec> <sec id="pedi12022-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Anti‐islet autoantibodies status and serum random C‐peptide at diagnosis define four distinct phenotypes of pediatric diabetes with prognostic value.</p> </sec> </abstract>