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Published on: July 5, 2022
Age-related heterogeneity of type 1 diabetes mellitus in children: a single-center retrospective study
Shi-Yang Gao1, Yi-Guo Huang1, Li-Bo Wang1
1Department of Endocrinology, Metabolism and Genetics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, DongFang Road, PuDong District, Shanghai, 200127, China.
Insights
Type 1 diabetes shows varied features across age groups. Early-onset T1DM in children indicates poorer islet function, while later onset increases metabolic complication risks, necessitating age-specific care.
Area of Science:
- Pediatric Endocrinology
- Immunology
- Metabolic Disorders
Background:
- Type 1 diabetes mellitus (T1DM) is an autoimmune disease with significant heterogeneity.
- Understanding age- and ethnicity-related differences is crucial for effective T1DM management and precision medicine.
- This study examines the clinical, metabolic, and immunological diversity of T1DM in children based on age at diagnosis.
Purpose of the Study:
- To investigate the heterogeneity of Type 1 diabetes mellitus in pediatric patients.
- To compare clinical, metabolic, and immunological characteristics across different age groups at diagnosis.
- To inform the development of age-specific management strategies for T1DM.
Main Methods:
- Retrospective analysis of 401 children newly diagnosed with T1DM.
- Comparison of cohort characteristics with international data.
- Categorization of patients into three age groups: 6 months-5 years, 5-10 years, and ≥10 years.
- Analysis of clinical, metabolic (C-peptide AUC), and immunological markers (lymphocyte subsets, cytokines).
Main Results:
- No significant differences in most clinical characteristics across age groups.
- Younger children (6 months-5 years) exhibited lower C-peptide AUC, indicating reduced islet function.
- Older children (≥10 years) showed higher rates of thyroid antibodies and vitamin D deficiency.
- Immunological analysis revealed increased T and B lymphocytes, decreased IL-2, and increased IL-6 in T1DM patients compared to controls. The youngest group had a higher CD4/CD8 ratio correlated with C-peptide AUC.
Conclusions:
- Type 1 diabetes mellitus presents significant heterogeneity in clinical, metabolic, and immunological features among children based on age at onset.
- Early-onset T1DM is associated with diminished islet function, while late-onset T1DM correlates with increased susceptibility to metabolic complications.
- Age-specific management approaches are essential for optimizing outcomes in pediatric T1DM patients.
Background:
Type 1 diabetes mellitus is a heterogeneous autoimmune disease with diverse characteristics between ethnicities and ages. Understanding this heterogeneity is essential for optimizing management and developing precision treatments. This study investigates the clinical, metabolic and immunological heterogeneity of type 1 diabetes mellitus in children across different ages of onset.
Methods:
A retrospective analysis of 401 children newly diagnosed with type 1 diabetes mellitus at a single center from January 2009 to August 2024 was conducted. We compared the clinical characteristics of our cohort with others from different countries. Patients were categorized into three age groups: 6 months-5 years, 5-10 years and ≥ 10 years at diagnosis. Clinical, metabolic, and immunological features were compared among groups.
Results:
The median cohort age was 8.58 years; 48.9% were male. Diabetic ketoacidosis occurred in 56.1% of patients, higher than in the Finnish and American cohorts. Most clinical characteristics are not significantly different among age groups. The 6 months-5 years group had a lower area under the curve (AUC) for C-peptide compared to the other age groups. The ≥ 10 years group was more likely to be thyroid antibody positive and have vitamin D deficiency. Immunologically, type 1 diabetes mellitus patients showed significantly increased counts of T lymphocytes, CD3 + CD8 + T cells and B lymphocytes, along with decreased interleukin-2 and increased interleukin-6 levels compared to healthy controls. Of note, the 6 months-5 years group had a higher CD4/CD8 ratio, which was negatively correlated with C-peptide AUC.
Conclusions:
Significant heterogeneity in type 1 diabetes mellitus features exists across age groups. Early-onset patients showed poorer islet function and late-onset patients were more prone to metabolic complications. Collectively our study emphasizes the need for age-specific management strategies.
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