Department of Endocrinology and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao-Tong University, Shanghai, China.
J Diabetes. 2019 Oct;11(10):818-825. doi: 10.1111/1753-0407.12912. Epub 2019 Apr 22.
This study investigated possible predictors of residual islet β-cell function (RBF) in young patients with newly diagnosed type 1 diabetes (T1D).
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.
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.
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.
本研究旨在探讨新诊断的 1 型糖尿病（T1D）年轻患者胰岛β细胞功能（RBF）残留的可能预测因素。
根据诊断时的年龄和疾病持续时间，对 443 例 T1D 患者的 RBF 进行分析，其中 110 例患者随访 18-60 个月。通过逻辑回归建立列线图，以探讨与长期 RBF 相关的因素。
在 443 例 T1D 患者中（平均[±SD]年龄 20.28±5.50 岁；平均[±SD]糖尿病病程 28.5±14.6 个月），64.3%的患者 RBF 得到保留。在随访队列中的 110 例患者中，RBF 不良结局的独立预测因素为发病年龄（比值比[OR]0.82；95%置信区间[CI]0.73-0.92；P<0.001）、高危人类白细胞抗原（HLA）状态（OR 4.73；CI 1.28-17.52；P=0.020）、女性（OR 3.39；CI 1.03-11.22；P=0.045）和糖尿病酮症酸中毒（DKA）病史（OR 8.71；CI 2.31-32.83；P<0.001）。基线谷氨酸脱羧酶（GAD）抗体、糖尿病家族史、体重指数、胰岛素剂量以及 C 肽和 HbA1c 水平与 RBF 不良结局无关。T1D 诊断后强化血糖控制可在平均（±SD）35.1±13.8 个月的随访中改善 RBF。预测概率与实际观察概率的校准图显示，列线图预测 2、3 和 4 年 RBF 的概率具有最佳一致性。
发病年龄较小、女性、HLA 风险较高和 DKA 病史是预测长期β细胞功能保存不良的主要因素。血糖控制可改善糖尿病病程中的 RBF。列线图为中国汉族人群新诊断的 T1D 患者提供了 RBF 的个体化风险估计。
