Negative association between type 1 diabetes and HLA DQB1*0602-DQA1*0102 is attenuated with age at onset

Background: Vestibular system is critical for maintaining balance and learning complex tasks. This study aimed to determine the frequencies, types, and predictors of vestibular dysfunctions (VDs) in children with type 1 diabetes (T1D) using videonystagmography (VNG). Patients and Methods: This study included 65 patients (children with T1D = 40; controls = 25). The patients underwent VNG. Results: Patients (boys = 15; girls = 25) had a mean age of 14.05 ± 1.82 years and duration of illness of 6.30 ± 2.84 years. The majority had frequent attacks of diabetic ketoacidosis (DKA) (65%) and hypoglycemia (40%). Dizziness was reported in 20%. VNG abnormalities were reported in 70% (n = 28), of them 71.43 and 28.57% had central and peripheral VDs, respectively. Dizziness was associated with peripheral VD. Compared to patients without VDs, those with VDs were older and had earlier age at onset and longer duration of diabetes (>5 years), higher levels of HbA1c (>7%), higher frequencies of DKA and hypoglycemic attacks, comorbid medical conditions, and diabetic complications. Multiple logistic regression analysis showed that presence of VNG abnormalities (VDs) was independently correlated with diabetes duration >5 years (odds ratio [OR] = 4.52 [95% confidence interval [CI] = 3.55–7.04], p = 0.001), HbA1c% levels >7% (OR = 3.42 [95% CI = 2.84–5.75], p = 0.001), and presence of hypoglycemic attacks (OR = 4.65 [95% CI = 2.85–7.55]). Conclusions: -VDs are prevalent in children with T1D and correlated with the duration and severity of diabetes and the occurrence of hypoglycemic attacks. Therefore, optimizing glycemic control and prevention and treatment of diabetic complications and comorbidities are important. Multidisciplinary follow-ups are required for early detection and management of diabetic VDs.

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Partial remission in children and adolescents with type 1 diabetes: an analysis based on the insulin dose-adjusted hemoglobin A1c

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2021-0048 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Emine Ayça Cimbek ◽

Aydın Bozkır ◽

Deniz Usta ◽

Nazım Ercüment Beyhun ◽

Ayşenur Ökten ◽

...

Keyword(s):

Type 1 Diabetes ◽

Partial Remission ◽

Hemoglobin A1c ◽

Insulin Dose ◽

Age At Onset ◽

Insulin Requirement ◽

C Peptide ◽

Factors Associated ◽

Daily Insulin

Abstract Objectives Most patients with type 1 diabetes (T1D) experience a transient phase of partial remission (PR). This study aimed to identify the demographic and clinical factors associated with PR. Methods This was a longitudinal retrospective cohort study of 133 children and adolescents with T1D. PR was defined by the gold standard insulin dose-adjusted hemoglobin A1c (HbA1c) (IDAA1c) of ≤9. Results Remission was observed in 77 (57.9%) patients. At diagnosis, remitters had significantly higher pH (7.3 ± 0.12 vs. 7.23 ± 0.15, p=0.003), higher C-peptide levels (0.45 ± 0.31 ng/mL vs. 0.3 ± 0.22, p=0.003), and they were significantly older (9.3 ± 3.6 years vs. 7.3 ± 4.2, p=0.008) compared with non-remitters. PR developed more frequently in patients without diabetic ketoacidosis (DKA) (p=0.026) and with disease onset after age 5 (p=0.001). Patients using multiple daily insulin regimen were more likely to experience PR than those treated with a twice daily regimen (63.9 vs. 32%, p=0.004). Only age at onset was an independent predictor of PR (OR: 1.12, 95% CI: 1-1.25; p=0.044). Remitters had lower HbA1c levels and daily insulin requirement from diagnosis until one year after diagnosis (p<0.001). PR recurred in 7 (9%) patients. The daily insulin requirement at three months was lower in remitters with PR recurrence compared to those without (0.23 ± 0.14 vs. 0.4 ± 0.17 U/kg/day, p=0.014). Conclusions Addressing factors associated with the occurrence of PR could provide a better comprehension of metabolic control in T1D. The lack of DKA and higher C-peptide levels may influence PR, but the main factor associated with PR presence was older age at onset. PR may recur in a small proportion of patients.

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Study of factors influencing susceptibility and age at onset of type 1 diabetes: A review of data from Continental Italy and Sardinia

World Journal of Diabetes ◽

10.4239/wjd.v5.i4.557 ◽

2014 ◽

Vol 5 (4) ◽

pp. 557 ◽

Cited By ~ 3

Author(s):

Fulvia Gloria-Bottini

Keyword(s):

Type 1 Diabetes ◽

Age At Onset ◽

Factors Influencing

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Higher age at onset of type 1 diabetes increases risk of macular oedema

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2012.02522.x ◽

2012 ◽

Vol 91 (8) ◽

pp. 709-715 ◽

Cited By ~ 5

Author(s):

Kustaa Hietala ◽

Carol Forsblom ◽

Paula Summanen ◽

Per-Henrik Groop ◽

Keyword(s):

Type 1 Diabetes ◽

Macular Oedema ◽

Age At Onset

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Children with type 1 diabetes of early age at onset – immune and metabolic phenotypes

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2019-0103 ◽

2019 ◽

Vol 32 (9) ◽

pp. 935-941

Author(s):

Madalena Sales Luis ◽

Margarida Alcafache ◽

Sara Ferreira ◽

Ana Laura Fitas ◽

Joana Simões Pereira ◽

...

Keyword(s):

Type 1 Diabetes ◽

Age At Onset ◽

Disease Onset ◽

Inverse Correlation ◽

Early Age ◽

Insulin Requirements ◽

Age Related ◽

One Year ◽

Immune Imbalance

Abstract Objectives We aimed to evaluate children with type 1 diabetes (T1D) with early age at onset (EAO) for clinical, immune and metabolic features in order to identify age-related disease phenotypes. Methods Comparative study of two groups of T1D children: EAO (≤5 years) and later age at onset (LAO; >5 years), regarding the presence of other autoimmune (AI) diseases, diabetes ketoacidosis and immunologic profile at onset and metabolic data 1 year after diagnosis. Statistical analysis was performed with significance set for p < 0.05. Results The study included 137 children (EAO = 52, mean age 3.6 ± 1.5 [mean ± standard deviation (SD)] and LAO = 85, mean age 10.4 ± 2.9). EAO was more associated with concomitant AI diseases (p = 0.032). Despite no differences in disease onset, EAO presented with lower C-peptide levels (p = 0.01) and higher absolute lymphocyte number (p < 0.0001), with an inverse correlation between these two variables (p = 0.028). Additionally, the EAO group had a higher frequency of serum detection of three antibodies (Abs) (p = 0.0008), specifically insulin Abs (p = 0.0001). One year after diagnosis, EAO had higher total daily insulin (TDI) dose (p = 0.008), despite similar hemoglobin A1c (HbA1c). Conclusions Our data show an association of EAO T1D with more AI diseases, higher number of Abs, lower initial insulin reservoir and higher insulin requirements 1 year after diagnosis. In this group, immune imbalance seems more evident and disease progression faster, probably reflecting distinct “immune environment” with different ages at disease onset. Further studies in the field of immunogenetics and immune tolerance are required, to improve patient stratification and find novel targets for therapeutic intervention.

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