Age of Diagnosis Does Not Alter the Presentation or Progression of Robustly Defined Adult-Onset Type 1 Diabetes
Author:
Thomas Nicholas J.12, Hill Anita V.2, Dayan Colin M.3ORCID, Oram Richard A.12ORCID, McDonald Timothy J.12ORCID, Shields Beverley M.1ORCID, Jones Angus G.12ORCID, Simon Godwin, Ramos Angelo, Norris Andrea, Tan Kai, Narendran Parth, Ramtoola Shenaz, Ali Amar, Banerjee Moulinath, Brooks Augustin, Chakera Ali, Johnson Andrew, Tatovic Danijela, Ballav Chitrabhanu, Dayan Colin, Nair Sunil, Game Francis, Beames Susan, Rayman Gerry, Snell Marie, Butler Susie, Beck Sarah, Beecham Janet, Wilding John, Rice Sam, Chen Mimi, Thiraviaraj Athinyaa, Sivappriyan Siva, Issa Basil, Humayun Asif, Hinch Rebecca, Krishnan Leena, Myint Khin Swe, Fox Charles, Prouten Jennifer, Sampson Mike, Mansell Peter, Chee Carolyn, Owen Katherine, Dimitropoulis Ioannis, Cummings Michael, Kavourra Foteini, Heald Adrian, Heller Simon, Sihota Sarbpreet, Muraleedharan Vakkat, Watson Tara, Price Hermione, Whittaker Roger, Orme Sarah, Field Ben, Bain Stephen, Battacharya Beas, Haxton Lesley, Pegler Suzannah, Thompson Catherine, Andrew Rob, Smith Jamie, Browne Duncan, Creely Steve, Yadav Rahul, Kakad Rakhi, Laji Ken, Kumar Mohit, Mohammadi Alirezi, Young James, Pramodh Seshadri, Jayagopal Vijay, Jones Angus, Hill Anita, Bolt Robert, Hammersley Suzanne, Aldred Migaila, Steele Anna, Tippett Peter,
Affiliation:
1. 1University of Exeter College of Medicine & Health, Exeter, U.K. 2. 2Royal Devon University Healthcare NHS Foundation Trust, Exeter, U.K. 3. 3Cardiff University, Cardiff, U.K.
Abstract
OBJECTIVE
To determine whether presentation, progression, and genetic susceptibility of robustly defined adult-onset type 1 diabetes (T1D) are altered by diagnosis age.
RESEARCH DESIGN AND METHODS
We compared the relationship between diagnosis age and presentation, C-peptide loss (annual change in urine C-peptide–creatinine ratio [UCPCR]), and genetic susceptibility (T1D genetic risk score [GRS]) in adults with confirmed T1D in the prospective StartRight study, 1,798 adults with new-onset diabetes. T1D was defined in two ways: two or more positive islet autoantibodies (of GAD antibody, IA-2 antigen, and ZnT8 autoantibody) irrespective of clinical diagnosis (n = 385) or one positive islet autoantibody and a clinical diagnosis of T1D (n = 180).
RESULTS
In continuous analysis, age of diagnosis was not associated with C-peptide loss for either definition of T1D (P > 0.1), with mean (95% CI) annual C-peptide loss in those diagnosed before and after 35 years of age (median age of T1D defined by two or more positive autoantibodies): 39% (31–46) vs. 44% (38–50) with two or more positive islet autoantibodies and 43% (33–51) vs. 39% (31–46) with clinician diagnosis confirmed by one positive islet autoantibody (P > 0.1). Baseline C-peptide and T1D GRS were unaffected by age of diagnosis or T1D definition (P > 0.1). In T1D defined by two or more autoantibodies, presentation severity was similar in those diagnosed before and after 35 years of age: unintentional weight loss, 80% (95% CI 74–85) vs. 82% (76–87); ketoacidosis, 24% (18–30) vs. 19% (14–25); and presentation glucose, 21 mmol/L (19–22) vs. 21 mmol/L (20–22) (all P ≥ 0.1). Despite similar presentation, older adults were less likely to be diagnosed with T1D, insulin-treated, or admitted to hospital.
CONCLUSIONS
When adult-onset T1D is robustly defined, the presentation characteristics, progression, and T1D genetic susceptibility are not altered by age of diagnosis.
Funder
Wellcome Trust NIHR Exeter Clinical Research Facility National Institute of Health European Foundation for the Study of Diabetes Care Research Exeter Biomedical Research Centre Care Research Exeter Clinical Research Facility NIHR National Institute for Health Diabetes UK
Publisher
American Diabetes Association
Subject
Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine
Cited by
2 articles.
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