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Islet autoantibody types mark differential clinical characteristics at diagnosis of pediatric type 1 diabetes
Author(s) -
Nieto Jacobo,
Castillo Beatriz,
Astudillo Marcela,
Tosur Mustafa,
Balasubramanyam Ashok,
Pietropaolo Massimo,
Redondo Maria J.
Publication year - 2021
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.13238
Subject(s) - autoantibody , medicine , type 1 diabetes , anti thyroid autoantibodies , islet , titer , thyroglobulin , diabetes mellitus , immunology , thyroid peroxidase , endocrinology , antibody , thyroid , insulin
Background We aimed to study whether islet autoantibody type marks differential characteristics at the time of type 1 diabetes (T1D) diagnosis. Methods We studied 711 children with newly diagnosed autoimmune T1D. We compared demographic (sex, age, race/ethnicity), clinical (pubertal development, BMI percentile, diabetic ketoacidosis [DKA]) and laboratory (glucose, hemoglobin A1c [HbA1c], C‐peptide, tissue transglutaminase antibodies [tTGA], thyroglobulin antibodies, and thyroid peroxidase antibodies [TPOA]) characteristics by presence/absence of autoantibodies to insulin (IAA), GAD65 (GADA), or IA‐2/ICA512 (IA‐2A). Islet autoantibody titers were evaluated among the children positive for the relevant autoantibody type. We used multivariable analysis to adjust for potential confounders. Results IAA+ was statistically associated with younger age ( p < 0.0001) and lower HbA1c ( p = 0.049) while Tanner stage, GADA status and number of positive islet autoantibodies were not significant in the multivariable model. GADA+ was associated with female sex (OR = 4.0, p = 0.002) and negatively with elevated tTGA titers (>50 U/mL) (OR = 0.21, p = 0.026) but not with age, IAA status, IA‐2A status, islet autoantibody number, or thyroid autoimmunity. None of the associations with IA‐2A positivity was statistically significant in the multivariable analysis. In multivariable models, IAA titer was significantly associated with younger age ( p = 0.006), DKA ( p = 0.017) and higher tTGA levels ( p = 0.002); GADA titer with female sex ( p = 0.028), racial minority ( p = 0.046) and TPOA positivity ( p = 0.021); and IA‐2A titer with older age ( p = 0.001) and not being African American ( p = 0.024). Conclusions Islet autoantibody type is associated with differential characteristics at diagnosis of pediatric T1D. Longitudinal and mechanistic studies are needed to evaluate T1D endotypes by autoantibody type.