Prevalence and Impact of Initial Misclassification of Pediatric Type 1 Diabetes Mellitus

Tripathi, Avnish; Rizvi, Ali A.; Knight, Lisa; Jerrell, Jeanette M.

doi:10.1097/smj.0b013e318268ca60

Cited by 22 publications

(15 citation statements)

References 13 publications

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“…Diabetes at young age is predominantly type 1 diabetes - a chronic autoimmune disease, caused by an interplay of genetic susceptibility and environmental factors [1, 2]. The incidence of type 1 diabetes is rising worldwide, particularly in young children [1, 3, 4], and varies from the lowest values reported in China and Venezuela (0.1 per 100,000 inhabitants per year) to the highest recorded in Finland (42.9 per 100,000 inhabitants per year) [2–4].…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of type 1 diabetes is rising worldwide, particularly in young children [1, 3, 4], and varies from the lowest values reported in China and Venezuela (0.1 per 100,000 inhabitants per year) to the highest recorded in Finland (42.9 per 100,000 inhabitants per year) [2–4]. DIAMOND project results showed the average 2.8% of annual increase in incidence of type 1 diabetes calculated from data of 103 centers [5].…”

Section: Introductionmentioning

confidence: 99%

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The course of diabetes in children, adolescents and young adults: does the autoimmunity status matter?

et al. 2016

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BackgroundInitial classification of diabetes of young may require revision to improve diagnostic accuracy of different forms of diabetes.The aim of our study was to examine markers of beta-cell autoimmunity in a cohort of young (0–25 years) patients with type 1 diabetes and compare the presentation and course of the disease according to the presence of pancreatic antibodies.MethodsCross-sectional population-based study was performed covering 100% of pediatric (n = 860) and 70% of 18–25 years old adult patients (n = 349) with type 1 diabetes in Lithuania.ResultsNo antibodies (GAD65, IA-2, IAA and ICA) were found in 87 (7.5%) cases. Familial history of diabetes was more frequent in those with antibodies-negative diabetes (24.1 vs. 9.4%, p < 0.001). Gestational age, birth weight and age at diagnosis was similar in both groups. Ketosis at presentation was more frequent in patients with autoimmune diabetes (88.1 vs. 73.5%, p < 0.05). HbA1c at the moment of investigation was 8.6 (3) vs. 8.7 (2.2)% in antibodies-negative and antibodies-positive diabetes groups, respectively, p > 0.05. In the whole cohort, neuropathy was found in 8.8% and nephropathy - in 8.1% of cases, not depending on autoimmunity status. Adjusted for age at onset, disease duration and HbA1c, retinopathy was more frequent in antibodies-negative subjects (13.8 vs. 7.8%, p < 0.05).ConclusionAntibodies-negative pediatric and young adult patients with type 1 diabetes in this study had higher incidence of family history of diabetes, higher frequency of retinopathy, less frequent ketosis at presentation, but similar age at onset, HbA1c, incidence of nephropathy and neuropathy compared to antibodies-positive patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The course of diabetes in children, adolescents and young adults: does the autoimmunity status matter?

et al. 2016

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“…Firstly, when a community-based clinical diabetes register was checked against death certifi cate data, the population with diabetes recorded on the death certifi cate was not representative of the actual population who had died with the disease: the presence of diabetes was underestimated by half for men and by a third for women [ 2 ] . Moreover, rates of initial misclassification of paediatric type 1 diabetes mellitus as timal use of resources [ 3 ] . Indeed, younger age at onset of type 1 diabetes and female gender is associated with higher risk of late complications of diabetes [ 8 ] .…”

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Epidemiology of Cardiovascular Disease in Patients with Type 1 Diabetes: European Perspective

Matteucci

Giampietro

2014

Exp Clin Endocrinol Diabetes

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The International Diabetes Federation estimated that 5.1 million people aged between 20 and 79 years died from diabetes in 2013, accounting for 8.4% of global all-cause mortality among people in this age group. Type 1 diabetes is associated with a 2- to 4-fold increased mortality risk compared with the general population. Before the onset of late complications, most of the excess mortality is from potentially preventable causes of death such as ketoacidosis, whereas the long-term excess mortality is largely due to cardiovascular disease. However, a wide geographic variation in mortality of type 1 diabetic patients has been evidenced and accurate estimates of mortality attributable to diabetes are difficult to obtain. The review provides an overview of currently available evidence and summarizes main problems in estimating early and long-term mortality by cause of death in type 1 diabetes, paying particular attention to European studies.

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“…The epidemic of overweight and obesity has made it increasingly difficult to clinically diagnose diabetes type, because insulin resistance and autoimmunity often coexist (8,9). Cohort studies of youth with type 1 diabetes have found a significant increase in microvascular and macrovascular diseases in those with concurrent insulin resistance (10–12).…”

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Albuminuria According to Status of Autoimmunity and Insulin Sensitivity Among Youth With Type 1 and Type 2 Diabetes

et al. 2013

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OBJECTIVETo evaluate whether etiologic diabetes type is associated with the degree of albuminuria in children with diabetes.RESEARCH DESIGN AND METHODSSEARCH is an observational, longitudinal study of children with diabetes. Youth with newly diagnosed diabetes were classified according to diabetes autoantibody (DAA) status and presence of insulin resistance. We defined insulin resistance as an insulin sensitivity score <25th percentile for the United States general youth population. DAA status was based on positivity for the 65-kD isoform of glutamate decarboxylase and insulinoma-associated protein 2 antigens. The four etiologic diabetes type groups were as follows: DAA+/insulin-sensitive (IS) (n = 1,351); DAA+/insulin-resistant (IR) (n = 438); DAA−/IR (n = 379); and DAA−/IS (n = 233). Urinary albumin:creatinine ratio (UACR) was measured from a random urine specimen. Multivariable regression analyses assessed the independent relationship between the four diabetes type groups and magnitude of UACR.RESULTSAdjusted UACR means across the four groups were as follows: DAA+/IS = 154 μg/mg; DAA+/IR = 137 μg/mg; DAA−/IR = 257 μg/mg; and DAA−/IS = 131 μg/mg (P < 0.005). Only DAA−/IR was significantly different. We performed post hoc multivariable regression analysis restricted to the two IR groups to explore the contribution of DAA status and insulin sensitivity (continuous) to the difference in UACR between the IR groups. Only insulin sensitivity was significantly associated with UACR (β = −0.54; P < 0.0001).CONCLUSIONSIn youth with diabetes, the DAA−/IR group had a greater UACR than all other groups, possibly because of the greater magnitude of insulin resistance. Further exploration of the relationships between severity of insulin resistance, autoimmunity, and albuminuria in youth with diabetes is warranted.

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Prevalence and Impact of Initial Misclassification of Pediatric Type 1 Diabetes Mellitus

Abstract: Proper categorization of pediatric diabetes can be challenging, especially with comorbid obesity. Failure to ascertain type 1 diabetes mellitus in a timely manner in a pediatric population may increase the risk of substandard care and diabetes-related complications.

Cited by 22 publications

References 13 publications

The course of diabetes in children, adolescents and young adults: does the autoimmunity status matter?

The course of diabetes in children, adolescents and young adults: does the autoimmunity status matter?

Epidemiology of Cardiovascular Disease in Patients with Type 1 Diabetes: European Perspective

Albuminuria According to Status of Autoimmunity and Insulin Sensitivity Among Youth With Type 1 and Type 2 Diabetes

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