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Racial and ethnic differences among children with new-onset autoimmune Type 1 diabetes
Insights
Hispanic children with new-onset autoimmune Type 1 diabetes showed higher C-peptide levels and obesity rates compared to non-Hispanic white children. These findings suggest ethnicity influences Type 1 diabetes development and may impact treatment strategies.
Area of Science:
- Pediatric Endocrinology
- Autoimmune Diseases
- Clinical Research
Background:
- Type 1 diabetes (T1D) exhibits heterogeneity in presentation and progression.
- Ethnic and racial disparities are increasingly recognized in pediatric autoimmune diseases.
- Understanding these differences is crucial for personalized medicine in Type 1 diabetes.
Purpose of the Study:
- To compare demographic and clinical characteristics of ethnic minority children with new-onset autoimmune Type 1 diabetes against non-Hispanic white children.
- To investigate potential ethnic variations in the pathogenesis of pediatric Type 1 diabetes.
Main Methods:
- Analysis of a single-center cohort of 712 children diagnosed with new-onset autoimmune Type 1 diabetes between January 2008 and March 2011.
- Comparison of clinical data including age, BMI percentile, sex, C-peptide levels, glucose levels, diabetic ketoacidosis, and Tanner stage across ethnic groups (Hispanic, African-American, non-Hispanic white).
Main Results:
- Hispanic children had higher C-peptide levels (P=0.004), elevated BMI (P<0.001), and higher rates of diabetic ketoacidosis (P=0.006) compared to non-Hispanic white children.
- African-American children showed higher glucose levels (P=0.017), increased ketoacidosis (P=0.001), and elevated BMI (P<0.001), with a lower proportion in the pre-pubertal stage (P=0.01).
- After adjustment for confounders, Hispanic children maintained higher C-peptide levels (P=0.01), suggesting distinct biological differences.
Conclusions:
- Ethnicity is associated with distinct clinical characteristics at the onset of pediatric autoimmune Type 1 diabetes.
- Hispanic children exhibit specific differences in C-peptide levels and metabolic profiles, indicating potential variations in pathogenesis.
- These findings underscore the role of ethnicity in Type 1 diabetes heterogeneity and may inform tailored interventions.
Aim:
To compare demographic and clinical characteristics among children from ethnic minorities and non-Hispanic white children with new-onset autoimmune Type 1 diabetes.
Methods:
We analysed a single-centre series of 712 children with new-onset autoimmune Type 1 diabetes between January 2008 and March 2011. The median (range) age was 9.7 (0.3-18.1) years, the mean (sd) BMI percentile was 69.7 (25.4) and 48.3% of the cohort were girls. The cohort comprised 57.3% non-Hispanic white, 20.5% Hispanic and 14.8% African-American children, and 7.4% were of other, mixed or unknown race.
Results:
The Hispanic subgroup, compared with non-Hispanic white subgroup, had a higher mean (sd) C-peptide level [0.82 (1.62) vs 0.55 (0.47) ng/ml; P=0.004), and a greater proportion of children with elevated BMI (overweight or obesity; 49.6% vs 32.5%; P<0.001) and diabetic ketoacidosis (51.8% vs 38.2%; P=0.006). The African-American group had a higher mean (sd) glucose level [24.4 (12.8) vs 21.4 (10.7) mmol/l; P=0.017], a greater proportion of children with ketoacidosis (56.7% vs 38.2%; P=0.001), a greater proportion with elevated BMI (52.9% vs 32.5%; P<0.001), and a lower proportion of children at pre-pubertal stage (49.0% vs 61.6%; P=0.01), and tended to have higher C-peptide levels [0.65 (0.59) vs 0.55 [0.47] ng/ml; P=0.079) compared with the non-Hispanic white children. The differences in C-peptide levels compared with non-Hispanic white children persisted for Hispanic (P=0.01) but not African-American children (P=0.29) after adjustment for age, sex, BMI, ketoacidosis, glucose, Tanner stage and autoantibody number.
Conclusion:
At the onset of paediatric autoimmune Type 1 diabetes, Hispanic, but not African-American children had higher C-peptide levels, after adjustment for potential confounders, compared with non-Hispanic white children. These findings suggest that ethnicity may contribute to the heterogeneity of Type 1 diabetes pathogenesis, with possible implications for intervention.
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