Children with type 1 diabetes of early age at onset – immune and metabolic phenotypes
-
Madalena Sales Luis
,
Margarida Alcafache
Abstract
Objectives
We aimed to evaluate children with type 1 diabetes (T1D) with early age at onset (EAO) for clinical, immune and metabolic features in order to identify age-related disease phenotypes.
Methods
Comparative study of two groups of T1D children: EAO (≤5 years) and later age at onset (LAO; >5 years), regarding the presence of other autoimmune (AI) diseases, diabetes ketoacidosis and immunologic profile at onset and metabolic data 1 year after diagnosis. Statistical analysis was performed with significance set for p < 0.05.
Results
The study included 137 children (EAO = 52, mean age 3.6 ± 1.5 [mean ± standard deviation (SD)] and LAO = 85, mean age 10.4 ± 2.9). EAO was more associated with concomitant AI diseases (p = 0.032). Despite no differences in disease onset, EAO presented with lower C-peptide levels (p = 0.01) and higher absolute lymphocyte number (p < 0.0001), with an inverse correlation between these two variables (p = 0.028). Additionally, the EAO group had a higher frequency of serum detection of three antibodies (Abs) (p = 0.0008), specifically insulin Abs (p = 0.0001). One year after diagnosis, EAO had higher total daily insulin (TDI) dose (p = 0.008), despite similar hemoglobin A1c (HbA1c).
Conclusions
Our data show an association of EAO T1D with more AI diseases, higher number of Abs, lower initial insulin reservoir and higher insulin requirements 1 year after diagnosis. In this group, immune imbalance seems more evident and disease progression faster, probably reflecting distinct “immune environment” with different ages at disease onset. Further studies in the field of immunogenetics and immune tolerance are required, to improve patient stratification and find novel targets for therapeutic intervention.
Author contributions: MSL was responsible for data collection and wrote the manuscript. MA collected the data, performed statistical analysis and revised the manuscript. SF collected the data and revised the manuscript. ALF was enrolled in patient recruitment and revised the manuscript. JSP initiated data collection and revised the manuscript. IC and LL revised the manuscript. CL initiated and supervised the project, co-wrote the manuscript and is the guarantor of this work. All authors discussed the results and approved the final version of the manuscript.
Conflict of interest: Nothing to declare.
Research funding: Nothing to declare.
Employment or leadership: Nothing to declare.
Honorarium: Nothing to declare.
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© 2019 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Original Articles
- Association of the 3′UTR polymorphism (rs11665896) in the FGF21 gene with metabolic status and nutrient intake in children with obesity
- Future glycemic control of children diagnosed with type 1 diabetes mellitus at toddler and preschool/school age
- Children with type 1 diabetes of early age at onset – immune and metabolic phenotypes
- Determination of cerebral edema with serial measurement of optic nerve sheath diameter during treatment in children with diabetic ketoacidosis: a longitudinal study
- Association between inflammation, oxidative stress, vitamin D, copper and zinc with pre-obesity and obesity in school children from the city of Podgorica, Montenegro
- Phenotypic diversity and correlation with the genotypes of pseudohypoaldosteronism type 1
- Start low, go slowly – mental abnormalities in young prolactinoma patients under cabergoline therapy
- Primary ovarian insufficiency in an adolescent population: clinical phenotype and diagnostic approach
- Novel combined insulin-like 3 variations of a single nucleotide in cryptorchidism
- Evaluation of the abdominopelvic region using MRI in patients with primary amenorrhea
- Benefits of aerobic training in girls with precocious puberty: involvement of CRP and cortisol
- The relationship between the olfactory bulb and precocious puberty: from the nose to the pituitary
- Short Communication
- Experience with intramuscular glucagon for infants with early neonatal hypoglycemia
- Case Reports
- A novel GATA6 variant in a boy with neonatal diabetes and diaphragmatic hernia: a familial case with a review of the literature
- Nephrogenic diabetes insipidus in a 15-year-old Hispanic female with a novel AQP2 mutation
- Pediatric stroke as the presenting symptom of new-onset type 1 diabetes mellitus without DKA: case report and literature review
- Panhypopituitarism from neurosarcoidosis in an adolescent: case report and literature review
Articles in the same Issue
- Frontmatter
- Original Articles
- Association of the 3′UTR polymorphism (rs11665896) in the FGF21 gene with metabolic status and nutrient intake in children with obesity
- Future glycemic control of children diagnosed with type 1 diabetes mellitus at toddler and preschool/school age
- Children with type 1 diabetes of early age at onset – immune and metabolic phenotypes
- Determination of cerebral edema with serial measurement of optic nerve sheath diameter during treatment in children with diabetic ketoacidosis: a longitudinal study
- Association between inflammation, oxidative stress, vitamin D, copper and zinc with pre-obesity and obesity in school children from the city of Podgorica, Montenegro
- Phenotypic diversity and correlation with the genotypes of pseudohypoaldosteronism type 1
- Start low, go slowly – mental abnormalities in young prolactinoma patients under cabergoline therapy
- Primary ovarian insufficiency in an adolescent population: clinical phenotype and diagnostic approach
- Novel combined insulin-like 3 variations of a single nucleotide in cryptorchidism
- Evaluation of the abdominopelvic region using MRI in patients with primary amenorrhea
- Benefits of aerobic training in girls with precocious puberty: involvement of CRP and cortisol
- The relationship between the olfactory bulb and precocious puberty: from the nose to the pituitary
- Short Communication
- Experience with intramuscular glucagon for infants with early neonatal hypoglycemia
- Case Reports
- A novel GATA6 variant in a boy with neonatal diabetes and diaphragmatic hernia: a familial case with a review of the literature
- Nephrogenic diabetes insipidus in a 15-year-old Hispanic female with a novel AQP2 mutation
- Pediatric stroke as the presenting symptom of new-onset type 1 diabetes mellitus without DKA: case report and literature review
- Panhypopituitarism from neurosarcoidosis in an adolescent: case report and literature review
