Relationship between islet autoantibody status and the clinical characteristics of children and adults with incident type 1 diabetes in a UK cohort. Issue 4 (4th April 2018)

• Record Type: Journal Article
• Authors: Bravis, Vassiliki; Kaur, Akaal; Walkey, Helen C; Godsland, Ian F; Misra, Shivani; Bingley, Polly J; Williams, Alistair J K; Dunger, David B; Dayan, Colin M; Peakman, Mark; Oliver, Nick S; Johnston, Desmond G
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• Is Part Of: BMJ open. Volume 8:Issue 4(2018)
• Publication Date: 2018-04-04
• Subjects: general diabetes -- epidemiology -- immunology -- paediatric endocrinology; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2017-020904
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: To describe the characteristics of children and adults with incident type 1 diabetes in contemporary, multiethnic UK, focusing on differences between the islet autoantibody negative and positive. Design: Observational cohort study. Setting: 146 mainly secondary care centres across England and Wales. Participants: 3312 people aged ≥5 years were recruited within 6 months of a clinical diagnosis of type 1 diabetes via the National Institute for Health Research Clinical Research Network. 3021 were of white European ethnicity and 291 (9%) were non-white. There was a small male predominance (57%). Young people <17 years comprised 59%. Main outcome measures: Autoantibody status and characteristics at presentation. Results: The majority presented with classical osmotic symptoms, weight loss and fatigue. Ketoacidosis was common (42%), especially in adults, and irrespective of ethnicity. 35% were overweight or obese. Of the 1778 participants who donated a blood sample, 85% were positive for one or more autoantibodies against glutamate decarboxylase, islet antigen-2 and zinc transporter 8. Presenting symptoms were similar in the autoantibody-positive and autoantibody-negative participants, as was the frequency of ketoacidosis (43%vs40%, P=0.3). Autoantibody positivity was less common with increasing age (P=0.0001), in males compared with females (82%vs90%, P<0.0001) and in people of non-white compared with white ethnicity (73%vs86%, P<0.0001). Body mass index was higher in autoantibody-negative adults than autoantibody-positive adults (median, IQR 25.5, 23.1–29.2vs23.9, 21.4–26.7 kg/m 2 ; P=0.0001). Autoantibody-negative participants were more likely to have a parent with diabetes (28%vs16%, P<0.0001) and less likely to have another autoimmune disease (4%vs8%, P=0.01). Conclusions: Most people assigned a diagnosis of type 1 diabetes presented with classical clinical features and islet autoantibodies. Although indistinguishable at an individual level, autoantibody-negative participants as a group demonstrated features more typically associated with other diabetes subtypes. Trial registration number: ISRCTN66496918 ; Pre-results.