medwireNews: Children with familial type 1 diabetes have different characteristics than children with sporadic diabetes, but longer-term results are similar, researchers say.
“Familial type 1 diabetes in this study was characterized by a younger age at the beginning and a higher prevalence of the associated autoimmune diseases compared to sporadic type 1 diabetes,” report Beate Karges (RWTH Aachen) and co-authors of the study.
The 3765 children (younger than 20 years) with familial diabetes identified in the DPV registry had an average age of 7.9 years at the time of diagnosis, compared with 9.7 years for the 53,606 children with sporadic type 1 diabetes.
The rate of autoimmune disease was 16.7% versus 13.6% in children with familial or sporadic diabetes. The most common autoimmune disease was thyroid disease (11.6 vs. 10.0%), followed by celiac disease (6.2 vs. 4.2%) and Addison (0.1 vs. 0.05%).
However, children with familial diabetes had lower glucose levels when presented than children with sporadic diabetes and less often diabetic ketoacidosis.
In particular, the average glucose levels were 390 versus 417 mg / dl (21.6 versus 23.1 mmol / l), the mean values for glycated hemoglobin (HbA1c) 9.7% versus 11.1% (83 versus 98 mmol / mol) and the ketoacidosis rates 11.9% versus 20.4%.
“It is likely that there is a higher level of disease awareness in [families with pre-existing type 1 diabetes] contributes to timely detection and diagnosis and thus to an earlier start of therapy for the second family member, ”write the researchers in Diabetes Care.
Notably, the 948 children who had familial type 1 diabetes but were the first to develop it in their family had the youngest onset age (median 6.5 years), the highest ketoacidosis rate (24.1%), and the highest mean blood sugar level (442 mg / dl; 24.5 mmol / l).
These results “suggest more aggressive autoimmunity in familial diabetes,” say Karges and his team.
In the long term, children with familial and sporadic type 1 diabetes had a similar disease course. The mean HbA1c levels for the first year after diagnosis were 7.1% and 7.2% (54 and 55 mmol / mol), respectively, and the mean daily insulin doses were 0.5 and 0.6 IU / kg.
However, children with familial diabetes had a slightly higher rate of partial remission at 64.1% than children with sporadic diabetes versus 61.2%, which was due to higher rates in children with a pre-existing family member with diabetes (66.5%) .
The researchers suggest that this is due to the early detection of diseases that allow early insulin treatment and promote the partial recovery of beta cells.
“Family expertise with type 1 diabetes therapy could explain better glycemic control in the first year, higher acceptance of insulin pump use during initial treatment, and fewer events of severe hypoglycemia in the relatively first group,” they add.
Overall, 34.1% of children with pre-existing type 1 diabetes in the family used an insulin pump for the first year, compared with 18.3% of children with intermittent diabetes.
Nonetheless, the team concludes that “familial and sporadic type 1 diabetes are generally similar,” meaning that the two subgroups in clinical trials for type 1 diabetes prevention, in spite of sporadic type 1 diabetes, largely People with familial diabetes are recruited that do not need to be differentiated much more often.
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Diabetes Care 2021; doi: 10.2337 / dc20-1829
