通过研究筛查确诊为1型糖尿病的儿童（青少年糖尿病自身免疫研究[DAISY]）与社区中确诊为1型糖尿病的儿童的代谢结果比较。
Comparison of Metabolic Outcomes in Children Diagnosed with Type 1 Diabetes Through Research Screening (Diabetes Autoimmunity Study in the Young [DAISY]) Versus in the Community.
作者信息
Chan Christine L, Taki Iman, Dong Fran, Hoffman Michelle, Norris Jill M, Klingensmith Georgeanna, Rewers Marian J, Steck Andrea K
机构信息
1 Children's Hospital Colorado and University of Colorado Denver , Aurora, Colorado.
2 Barbara Davis Center for Childhood Diabetes, University of Colorado Denver , Aurora, Colorado.
出版信息
Diabetes Technol Ther. 2015 Sep;17(9):649-56. doi: 10.1089/dia.2015.0029. Epub 2015 Jun 3.
BACKGROUND
Children with positive islet autoantibodies monitored prospectively avoid metabolic decompensation at type 1 diabetes (T1D) diagnosis. However, the effects of early diagnosis and treatment on preservation of insulin secretion and long-term metabolic control are unknown. We compared characteristics of children detected through research screening (Diabetes Autoimmunity Study in the Young [DAISY]) versus community controls at baseline and, in a subset, 6- and 12-month metabolic outcomes.
MATERIALS AND METHODS
This was a case-control study comparing DAISY children with T1D to children diagnosed in the general community. All participants underwent mixed-meal tolerance testing; a subset wore a continuous glucose monitoring (CGM) device. Fasting and stimulated C-peptide levels, insulin dose-adjusted hemoglobin A1c (IDAA1c), and CGM variables were compared.
RESULTS
Children (21 DAISY, 21 community) were enrolled and matched by age, time of diagnosis, and diabetes duration; 18 were enrolled within 2 months and 24 within 2.5 years on average from diagnosis. In the overall group and the subgroup of participants enrolled 2.5 years from diagnosis, there were no IDAA1c or C-peptide differences between DAISY versus community children. The subgroup of DAISY versus community children enrolled near diagnosis, however, had lower baseline hemoglobin A1c (6.5±1.4% vs. 9.2±2.9%; P=0.0007) and IDAA1c (7.4±2.1% vs. 11.2±3.5%; P=0.04) and higher stimulated C-peptide (2.5±0.5 vs. 1.6±0.2 ng/mL; P=0.02). In this subgroup, IDAA1c differences persisted at 6 months but not at 1 year. CGM analyses revealed lower minimum overnight glycemia in community children (72 vs. 119 mg/dL; P=0.01).
CONCLUSIONS
Favorable patterns of IDAA1c and C-peptide seen in research-screened versus community-diagnosed children with T1D within 2 months of diagnosis are no longer apparent 1 year from diagnosis.
背景
对胰岛自身抗体呈阳性的儿童进行前瞻性监测可避免1型糖尿病（T1D）诊断时出现代谢失代偿。然而，早期诊断和治疗对胰岛素分泌保存及长期代谢控制的影响尚不清楚。我们比较了通过研究筛查（青少年糖尿病自身免疫研究[DAISY]）检测出的儿童与社区对照儿童在基线时的特征，并在一个亚组中比较了6个月和12个月时的代谢结果。
材料与方法
这是一项病例对照研究，将DAISY研究中的T1D儿童与在普通社区诊断出的儿童进行比较。所有参与者均接受混合餐耐量测试；一个亚组佩戴连续血糖监测（CGM）设备。比较空腹和刺激后的C肽水平、胰岛素剂量调整糖化血红蛋白（IDAA1c）以及CGM变量。
结果
共纳入儿童（21名DAISY儿童，21名社区儿童），并按年龄、诊断时间和糖尿病病程进行匹配；平均而言，18名在诊断后2个月内纳入，24名在诊断后2.5年内纳入。在总体组以及诊断后2.5年纳入的参与者亚组中，DAISY儿童与社区儿童之间的IDAA1c或C肽水平无差异。然而，在诊断时附近纳入的DAISY儿童与社区儿童亚组中，基线糖化血红蛋白较低（6.5±1.4%对9.2±2.9%；P = 0.0007），IDAA1c较低（7.4±2.1%对11.2±3.5%；P = 0.04），刺激后的C肽较高（2.5±0.5对1.6±0.2 ng/mL；P = 0.02）。在该亚组中，IDAA1c差异在6个月时持续存在，但在1年时不存在。CGM分析显示社区儿童夜间最低血糖较低（72对119 mg/dL；P = 0.01）。
结论
在诊断后2个月内，研究筛查出的T1D儿童与社区诊断出的儿童相比，IDAA1c和C肽的有利模式在诊断后1年时不再明显。
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