Çakmak Ramazan, Çaklılı Özge Telci, Ok Ayşe Merve, Mutlu Ümmü, Sarıbeyliler Göktuğ, Nasifova Vefa Seferova, Bilgin Ersel, Çoşkun Aylin, Guzey Damla Yenersu, Soyaltin Utku Erdem, Yüce Servet, Hacışahinoğulları Hülya, Yalın Gülşah Yenidünya, Selçukbiricik Özlem Soyluk, Gül Nurdan, Üzüm Ayşe Kubat, Karşıdağ Kubilay, Dinççağ Nevin, Yılmaz Mehmet Temel, Satman Ilhan
Department of Internal Medicine and Division of Endocrinology and Metabolic Diseases, Istanbul Health and Technology University, Istanbul, Türkiye.
Department of Internal Medicine and Division of Endocrinology and Metabolic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye.
J Diabetes Res. 2025 Apr 9;2025:8860118. doi: 10.1155/jdr/8860118. eCollection 2025.
The age-at-onset is of great importance in the heterogeneity of Type 1 diabetes mellitus (T1DM). This study was designed to define clinical and laboratory differences between child-adolescent-onset and adult-onset T1DM at presentation and during follow-up and determine the predicting factors for developing microvascular and macrovascular complications. This retrospective observational study evaluated T1DM patients who were followed in the diabetes outpatient clinic between January 1, 2000, and December 31, 2019. The study cohort included 490 individuals with T1DM (54.3% female, 58.8% adult-onset, and median follow-up: 5 years). In the adult-onset group, baseline C-peptide and GADA prevalence were higher, whereas presentation with ketoacidosis was 2.3-fold lower compared to the child-adolescent-onset group ( < 0.001). During follow-up, the adult-onset group had a 2.4-fold higher overweight/obesity ( < 0.001) and 1.7-fold higher dyslipidemia/hyperlipidemia ( = 0.002) than the child-adolescent-onset group. In multivariate analysis, fasting glucose ( = 0.024) in adult-onset, dyslipidemia/hyperlipidemia ( = 0.037) in child-adolescent-onset, and diabetes duration ( = 0.008 and = 0.007) and hypertension ( = 0.001 and = 0.01) in both groups were associated with increased risk of microvascular complications, whereas age-at-onset ( = 0.024), dyslipidemia/hyperlipidemia ( = 0.03), nephropathy ( = 0.003), and neuropathy ( = 0.001) in adult-onset and age ( = 0.002) and triglycerides ( = 0.013) in child-adolescent-onset groups were associated with increased risk of macrovascular complications. The cutoff C-peptide levels at baseline predicted microvascular complications in the whole cohort and adult-onset group were defined as 0.383 ng/mL ( < 0.001) and 0.41 ng/mL ( = 0.001), respectively. In the Kaplan-Meier analysis, C-peptide (< 0.383 ng/mL) but not age-at-onset predicted future development of microvascular and macrovascular complications ( = 0.003 and = 0.032). Clinical presentation and prognosis differ in adult-onset and child-adolescent-onset T1DM. Low initial C-peptide may predict the development of microvascular and macrovascular complications.
发病年龄在1型糖尿病（T1DM）的异质性中具有重要意义。本研究旨在明确儿童青少年起病型和成人起病型T1DM在初诊时及随访期间的临床和实验室差异，并确定发生微血管和大血管并发症的预测因素。这项回顾性观察性研究评估了2000年1月1日至2019年12月31日期间在糖尿病门诊接受随访的T1DM患者。研究队列包括490例T1DM患者（女性占54.3%，成人起病型占58.8%，中位随访时间：5年）。在成人起病组中，基线C肽和谷氨酸脱羧酶自身抗体（GADA）患病率较高，而与儿童青少年起病组相比，酮症酸中毒的发生率低2.3倍（P<0.001）。在随访期间，成人起病组超重/肥胖的发生率比儿童青少年起病组高2.4倍（P<0.001），血脂异常/高脂血症的发生率高1.7倍（P = 0.002）。多因素分析显示，成人起病型的空腹血糖（P = 0.024）、儿童青少年起病型的血脂异常/高脂血症（P = 0.037）以及两组的糖尿病病程（P = 0.008和P = 0.007）和高血压（P = 0.001和P = 0.01）与微血管并发症风险增加相关，而成人起病型的发病年龄（P = 0.024）、血脂异常/高脂血症（P = 0.03）、肾病（P = 0.003）和神经病变（P = 0.001）以及儿童青少年起病型的年龄（P = 0.002）和甘油三酯（P = 0.013）与大血管并发症风险增加相关。基线时的C肽水平临界值预测了整个队列中的微血管并发症，成人起病组和儿童青少年起病组的临界值分别定义为0.383 ng/mL（P<0.001）和0.41 ng/mL（P = 0.001）。在Kaplan-Meier分析中，C肽（<0.383 ng/mL）而非发病年龄预测了微血管和大血管并发症的未来发生情况（P = 0.003和P = 0.032）。成人起病型和儿童青少年起病型T1DM的临床表现和预后不同。初始C肽水平低可能预测微血管和大血管并发症的发生。
