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[Factors affecting C-peptide level during the first year of type 1 diabetes in children]
Agnieszka Zmysłowska1, Agnieszka Szadkowska, Witalij Andrzejewski
1Klinika Chorób Dzieci Instytutu Pediatrii UM w Łodzi, Łódź, Poland. agazmysl@poczta.onet.pl
Insights
In children with type 1 diabetes, younger age, autoantibodies, and severe ketoacidosis at diagnosis predict lower C-peptide levels, indicating reduced insulin secretion. These factors help predict residual insulin production in pediatric type 1 diabetes.
Area of Science:
- Pediatric Endocrinology
- Immunology of Diabetes
- Metabolic Disorders
Background:
- C-peptide levels are crucial for assessing endogenous insulin secretion in type 1 diabetes (T1D).
- Understanding factors influencing early C-peptide levels is vital for managing T1D in children.
Purpose of the Study:
- To determine if age at onset, gender, autoantibodies, ketoacidosis, insulin needs, and HbA1c predict C-peptide levels in the first year of T1D in children.
- To identify early indicators of residual insulin secretion in pediatric T1D.
Main Methods:
- 122 children (2-18 years) with T1D were studied.
- Fasting C-peptide levels were measured via radioimmunoassay at diagnosis and up to 12 months.
- Autoantibodies (ICA, GADA, IA2A) were detected at diagnosis.
Main Results:
- Younger age at onset positively correlated with C-peptide levels.
- C-peptide levels decreased one year post-diagnosis in patients with islet cell antibodies (ICA) and glutamic acid decarboxylase antibodies (GADA).
- Logistic regression indicated that male gender, younger age, low pH, higher HbA1c, and insulin requirement at onset were associated with decreased C-peptide levels at diagnosis.
Conclusions:
- Early indicators like young age, presence of diabetes-related autoantibodies, and severe ketoacidosis with hyperglycemia at onset are linked to diminished residual insulin secretion in children with T1D.
- These findings highlight potential predictors for assessing insulin secretion capacity in pediatric T1D.
Background:
C-peptide level is the most reliable factor evaluating the endogenous insulin secretion in patients with type 1 diabetes.
Objectives:
The aim of the study was to investigate whether the age at onset, gender, presence of autoantibodies and ketoacidosis at diagnosis and insulin requirement, HbA1c levels could be applied to predict the C-peptide levels in the first year of type 1 diabetes in children.
Material And Methods:
122 type 1 diabetic children, aged: 2-18 years (average 11.2), 44 female and 78 male were studied. Fasting C-peptide levels were examined by radioimmunoassay at diagnosis, after 10 days and after 1, 2, 3, 6 and 12 months of disease. At diagnosis islet cell antibodies (ICA) were detected by indirect immunofluorescence, antibodies to glutamic acid decarboxylase (GADA) and tyrosine phosphatase antibodies (IA2A) were measured by microradioimmunoprecipitation assay.
Results:
Age at onset was positively correlated to C-peptide levels at each evaluated point of the disease (r=0.3-0.46, p<0.0001). One year after diagnosis C-peptide levels decreased in ICA(+) (p<0.04) and GADA(+) (p<0.002) patients but not in ICA(-) or GADA(-) children. There was no significant difference between the IA2A-positive and negative subjects in the C-peptide levels at 12th month of disease. C-peptide level was also related to ketoacidosis at diagnosis, insulin requirement and HbA1c levels during the first year of type 1 diabetes. Logistic regression analysis showed that male, younger age, low pH, higher HbA1c and insulin requirement at onset were associated with decreased C-peptide level at diagnosis (p<0.00002).
Conclusions:
Young age, presence of diabetes-related autoantibodies and hyperglycaemia with severe acidosis at the disease onset may be associated with a decreased residual insulin secretion in type 1 diabetes in children.
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