Undergraduate School, Rice University, Houston, Texas, USA.
School of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Pediatr Diabetes. 2021 Sep;22(6):882-888. doi: 10.1111/pedi.13238. Epub 2021 May 31.
We aimed to study whether islet autoantibody type marks differential characteristics at the time of type 1 diabetes (T1D) diagnosis.
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.
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).
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.
我们旨在研究胰岛自身抗体类型是否在 1 型糖尿病（T1D）诊断时具有不同的特征。
我们研究了 711 例新诊断的自身免疫性 T1D 患儿。我们比较了不同的特征，包括人口统计学特征（性别、年龄、种族/民族）、临床特征（青春期发育、BMI 百分位、糖尿病酮症酸中毒[DKA]）和实验室特征（血糖、糖化血红蛋白[HbA1c]、C 肽、组织转谷氨酰胺酶抗体[tTGA]、甲状腺球蛋白抗体和甲状腺过氧化物酶抗体[TPOA]），这些特征与胰岛素（IAA）、GAD65（GADA）或 IA-2/ICA512（IA-2A）自身抗体的存在/缺失有关。我们在相关自身抗体阳性的儿童中评估了胰岛自身抗体滴度。我们使用多变量分析来调整潜在的混杂因素。
IAA+与年龄较小（p<0.0001）和 HbA1c 较低（p=0.049）相关，而在多变量模型中，Tanner 分期、GADA 状态和阳性胰岛自身抗体数量无显著差异。GADA+与女性（OR=4.0，p=0.002）相关，与升高的 tTGA 滴度（>50 U/mL）（OR=0.21，p=0.026）呈负相关，但与年龄、IAA 状态、IA-2A 状态、胰岛自身抗体数量或甲状腺自身免疫无关。IA-2A 阳性与多变量分析中的任何关联均无统计学意义。在多变量模型中，IAA 滴度与年龄较小（p=0.006）、DKA（p=0.017）和较高的 tTGA 水平（p=0.002）显著相关；GADA 滴度与女性（p=0.028）、少数民族（p=0.046）和 TPOA 阳性（p=0.021）相关；IA-2A 滴度与年龄较大（p=0.001）和非非裔美国人（p=0.024）相关。
胰岛自身抗体类型与儿科 T1D 诊断时的不同特征有关。需要进行纵向和机制研究，以根据自身抗体类型评估 T1D 亚型。
