Residual beta-cell function in diabetes children followed and diagnosed in the TEDDY study compared to community controls

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Abstract
Objective To explore whether children diagnosed with type 1 diabetes during islet autoantibody surveillance through The Environmental Determinants of Diabetes in the Young (TEDDY) study retain greater islet function than children diagnosed through the community. Methods TEDDY children identified at birth with high‐risk human leukocyte antigen and followed every 3 months until diabetes diagnosis were compared to age‐matched children diagnosed with diabetes in the community. Both participated in long‐term follow up after diagnosis. Hemoglobin A1c (HbA1c) and mixed meal tolerance test were performed within 1 month of diabetes onset, then at 3, 6, and 12 months, and biannually thereafter. Results Comparison of 43 TEDDY and 43 paired control children showed that TEDDY children often had no symptoms (58%) at diagnosis and none had diabetic ketoacidosis (DKA) compared with 98% with diabetes symptoms and 14% DKA in the controls (P < 0.001 and P = 0.03, respectively). At diagnosis, mean HbA1c was lower in TEDDY (6.8%, 51 mmol/mol) than control (10.5%, 91 mmol/mol) children (P < 0.0001). TEDDY children had significantly higher area under the curve and peak C‐peptide values than the community controls throughout the first year postdiagnosis. Total insulin dose and insulin dose‐adjusted A1c were lower throughout the first year postdiagnosis for TEDDY compared with control children. Conclusions Higher C‐peptide levels in TEDDY vs community‐diagnosed children persist for at least 12 months following diabetes onset and appear to represent a shift in the disease process of about 6 months. Symptom‐free diagnosis, reduction of DKA, and the potential for immune intervention with increased baseline C‐peptide may portend additional long‐term benefits of early diagnosis.
Funding Information
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK63829, U01 DK63861, U01 DK63821, U01 DK63863, U01 DK63790, UC4 DK63829, UC4 DK63861, UC4 DK63821, UC4 DK63863, UC4 DK95300, HHSN267200700014C)
  • National Institute of Allergy and Infectious Diseases
  • National Institute of Child Health and Human Development
  • National Institute of Environmental Health Sciences
  • Centers for Disease Control and Prevention
  • University of Florida (UL1 TR000064)
  • University of Colorado (UL1 TR001082)
  • Juvenile Diabetes Research Foundation (17-2011-274)

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