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The epidemiology of lost residual beta-cell function in short term diabetic children
G Dahlquist1, L Blom, B Persson
1Department of Pediatrics, Karolinska Institute, Stockholm, Sweden.
Insights
In children with type 1 diabetes, beta-cell function loss occurred in 64% by 30 months. This loss showed a reversed age dependency compared to clinical onset, differing in sex, season, and geography.
Area of Science:
- Pediatric Endocrinology
- Diabetes Research
- Immunology
Background:
- Childhood type 1 diabetes (T1D) involves autoimmune destruction of pancreatic beta cells.
- Understanding the progression of beta-cell function loss is crucial for managing T1D.
- Previous studies have focused on clinical onset, with less known about factors influencing beta-cell decline.
Purpose of the Study:
- To investigate the incidence and epidemiological characteristics of lost beta-cell function in children with T1D.
- To compare the epidemiology of beta-cell function loss with the epidemiology of clinical T1D onset.
Main Methods:
- Utilized the Swedish Childhood Diabetes Register, analyzing data from 526 children with T1D (6-30 months duration).
- Measured 24-hour urinary C-peptide excretion to assess beta-cell function, defining loss as <10% of healthy children's mean excretion.
- Analyzed incidence by sex, season, age, and geographical location, comparing with clinical onset data.
Main Results:
- The cumulative incidence of lost beta-cell function reached 0.64 by 30 months.
- Incidence did not differ by sex or season at onset.
- A reversed age dependency was observed for beta-cell function loss, with higher incidence in younger children, unlike clinical onset.
- No significant geographical variation was found for beta-cell function loss.
Conclusions:
- Epidemiological patterns of beta-cell function loss in childhood T1D differ significantly from those of clinical onset.
- Age, sex, seasonal, and geographical factors influencing clinical T1D onset may not directly determine the rate of beta-cell function decline.
- These findings suggest distinct underlying mechanisms or contributing factors for disease progression versus initial presentation.
Abstract:
Using the country-wide Swedish childhood diabetes register 526 children, who had had diabetes for 6-30 months were traced for measurements of 24-hour urinary C-peptide. Lost beta-cell function was defined as a 24-hour urinary C-peptide excretion per kg body weight less than 10% of the mean for healthy children (less than 0.025 nmol/kg). The estimated cumulative incidence of lost beta-cell function was 0.64 at 30 months. The incidence of lost beta-cell function did not differ by sex. Neither was there any significant variation in season at onset for cases with lost beta-cell function. A significant age dependency was shown for the cumulative incidence of lost beta-cell function with the highest incidence in the young age groups, i.e. a reversed age dependency compared to that of clinical onset. In contrast to the clinical onset of diabetes no significant geographical variation was found for lost beta-cell function when comparing standardized morbidity ratios. The urinary C-peptide excretion was significantly correlated to age at onset but not to degree or duration of ketonuria at onset. It is concluded that there are striking differences when comparing the epidemiology of lost beta-cell function to that of clinical onset in terms of age, sex, seasonal and geographical variations. The timing of clinical onset may thus partly be determined by factors different from those determining the rate of fall in beta-cell function.