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Published on: June 25, 2012
Residual beta-cell function in diabetes children followed and diagnosed in the TEDDY study compared to community
Andrea K Steck1, Helena Elding Larsson2, Xiang Liu3
1Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, Colorado.
Insights
Children diagnosed with type 1 diabetes through early surveillance (The Environmental Determinants of Diabetes in the Young study) maintained better islet function. Early detection led to fewer symptoms and diabetic ketoacidosis at diagnosis, with improved C-peptide levels persisting for at least 12 months.
Area of Science:
- Endocrinology
- Immunology
- Pediatric Diabetes Research
Background:
- Type 1 diabetes (T1D) diagnosis in children often occurs after significant beta-cell loss.
- Early detection strategies aim to identify T1D at earlier stages, potentially preserving residual beta-cell function.
Purpose of the Study:
- To compare islet function in children diagnosed with T1D through proactive surveillance (The Environmental Determinants of Diabetes in the Young - TEDDY study) versus those diagnosed through community-based identification.
- To evaluate clinical outcomes and metabolic markers at diagnosis and during the first year post-diagnosis.
Main Methods:
- Comparison of 43 TEDDY participants with 43 age-matched community-diagnosed T1D children.
- Assessment of Hemoglobin A1c (HbA1c) and mixed meal tolerance tests within one month of diagnosis and at subsequent follow-ups.
- Longitudinal monitoring of clinical symptoms, diabetic ketoacidosis (DKA) incidence, C-peptide levels, and insulin requirements.
Main Results:
- TEDDY participants were more likely to be asymptomatic (58%) and free of DKA at diagnosis compared to community controls (98% symptomatic, 14% DKA).
- Mean HbA1c was significantly lower in TEDDY children (6.8%) versus controls (10.5%) at diagnosis.
- TEDDY children exhibited higher C-peptide levels and lower insulin doses throughout the first year post-diagnosis.
Conclusions:
- Early T1D diagnosis via surveillance preserves islet function, evidenced by sustained higher C-peptide levels for at least 12 months post-onset.
- Symptom-free diagnosis and reduced DKA incidence in the TEDDY cohort suggest a potential 6-month delay in disease progression.
- Increased baseline C-peptide may facilitate future immune-based interventions, offering long-term benefits for early-diagnosed T1D patients.
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.
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