Prognosis for residual islet β‐cell secretion function in young patients with newly diagnosed type 1 diabetes

Abstract

Background This study investigated possible predictors of residual islet β‐cell function (RBF) in young patients with newly diagnosed type 1 diabetes (T1D). Methods After analyzing RBF in 443 patients with T1D according to age at diagnosis and disease duration, 110 were followed‐up over 18‐60 months. A nomogram was developed by logistic regression to explore factors associated with long‐term RBF. Results Of the 443 T1D patients (mean [±SD] age 20.28 ± 5.50 years; mean [±SD] diabetes duration 28.5 ± 14.6 months), RBF was preserved in 64.3%. Independent predictors for poor RBF outcome among the 110 patients in the follow‐up cohort were age at onset (odds ratio [OR] 0.82; 95% confidence interval [CI] 0.73‐0.92; P < 0.001), high‐risk human leukocyte antigen (HLA) status (OR 4.73; CI 1.28‐17.52; P = 0.020), female sex (OR 3.39; CI 1.03‐11.22; P = 0.045), and a history of diabetic ketoacidosis (DKA; OR 8.71; CI 2.31‐32.83; P < 0.001). Baseline glutamic acid decarboxylase (GAD) antibody, family history of diabetes, body mass index, insulin dosage, and C‐peptide and HbA1c levels were not associated with poor RBF outcome. Intensive glycemic control after T1D diagnosis may improve RBF within a mean (±SD) follow‐up of 35.1 ± 13.8 months. The calibration plot for the probability of 2‐, 3‐, and 4‐year RBF showed optimal agreement between nomogram‐predicted and actual observed probabilities. Conclusions Younger age of onset, female sex, higher HLA risk status, and a history of DKA were the main factors predicting long‐term poor preserved β‐cell function. Glycemic control could improve RBF during the course of diabetes. The nomogram provides an individualized risk estimate of RBF in patients with newly diagnosed T1D within Chinese Han populations.

Preserved C-peptide is common and associated with higher time in range in Chinese type 1 diabetes

“…Previous studies have suggested that age at diagnosis, duration of diabetes, autoantibody positivity, and Human Leukocyte antigen (HLA) genotype may influence serum C-peptide level (10,14,15). Our results were consistent with the previous studies that diabetes duration was negatively associated with residual b-cell function and that autoantibody positivity was correlated with sustained intrinsic insulin production (1,13,16). The relationship between longer disease duration and lower C-peptide is widely recognized according to previous studies, whereas the finding of a strong relationship between higher autoantibody levels and higher Cpeptide levels is difficult to interpret.…”

“…In another study of 109 participants with T1D followed for at least 10 years, Cheng et al showed that 38.5% of participants had detectable C-peptide secretion (random C-peptide ≥16.7 pmol/L) (12). Miao and colleagues reported that, in 443 participants with T1D for 2.38 years, stimulated C-peptide ≥200 pmol/L was detected in 64.3% of participants (13). To our knowledge, our study was the largest with a relatively long duration of diabetes in the Chinese population with T1D and suggested that more than half of them still had preserved insulin secretion.…”

Insulin Requirement and Complications Associated With Serum C-Peptide Decline in Patients With Type 1 Diabetes Mellitus During 15 Years After Diagnosis

“…This is why several studies were performed to assess the factors that are associated with residual C-peptide levels. Older age at diagnosis is one of the most commonly discussed factors that are associated with residual beta cell function ( 17 , 32 – 34 ). C-peptide level at initial diagnosis is lower in prepubertal children than in adolescent and young adults and declines more rapidly in younger children ( 35 ).…”

“…Our data showed no significant correlation between BMI SDS and serum C-peptide levels when taking the duration since diagnosis into consideration, but the mean C-peptide level was higher in the group with a BMI SDS over zero. Furthermore, intensive insulin therapy is known to sustain endogenous insulin secretion, lower the risk for hypoglycemia, and reduce diabetes complications in T1DM patients ( 34 , 39 ). All patients in our study were treated with intensive insulin therapy by multiple daily injections or through an insulin pump since 2010.…”