Rapid and Slow Progressors Toward β-Cell Depletion and Their Predictors in Type 1 Diabetes: Prospective Longitudinal...

This study aimed to investigate the progression of β-cell dysfunction and its predictors in Japanese patients with type 1 diabetes, using data from the nationwide, multicenter, prospective longitudinal Japanese Type 1 Diabetes Database Study (TIDE-J).

TIDE-J enrolled 314 Japanese individuals with type 1 diabetes, including 165 with acute-onset, 105 with slowly progressive, and 44 with fulminant type 1 diabetes. Clinical data, including C-peptide levels, glycemic control, and autoantibody status, were collected annually for up to 14 years. HLA genotypes were analyzed at study entry. The time to insulin depletion was analyzed using survival curves and Cox proportional hazards models to determine predictive factors.

The rate of undetectable C-peptide varied significantly among subtypes. At 5 years after onset, 43.1% (n = 55) of patients with acute-onset, 9.1% (n = 7) with slowly progressive, and 93.2% (n = 38) with fulminant type 1 diabetes reached undetectable C-peptide. Even within acute-onset type 1 diabetes, a marked interindividual variation was observed in the progression toward β-cell depletion. HLA genotypes influenced progression rates as follows: DRB1*04:05-DQB1*04:01/DRB1*04:05-DQB1*04:01 (DR4/DR4) carriers exhibited slower β-cell depletion, whereas DR4/DRB1*08:02-DQB1*03:02 (i.e., DR4/DR8) and DR4/DRB1*09:01-DQB1*03:03 (i.e., DR4/DR9) were associated with a rapid progression. For slowly progressive type 1 diabetes, low BMI, GAD antibody positivity, and absence of the DRB1*15:01-DQB1*06:02 or DRB1*15:02-DQB1*06:01 (i.e., DR2) haplotype were predictive of progression to insulin dependence.

This study elucidates the heterogeneity in β-cell dysfunction among Japanese individuals with type 1 diabetes and identifies genetic and clinical predictors of disease progression. These findings provide insights for individualized management strategies and future therapeutic interventions.