Clinical characteristics of type 1 diabetes mellitus in Taiwanese children aged younger than 6 years: A single-center experience

Chen, Yi‐Chen; Tung, Yung-Liang; Liu, Shih-Yao; Lee, Cheng-Ting; Tsai, Wen–Yu

doi:10.1016/j.jfma.2016.07.005

Cited by 22 publications

(28 citation statements)

References 28 publications

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“…We also observed lower rates of PREM in children and adolescents who had DKA at T1D diagnosis, which corroborate previous studies . Indeed, in youth newly diagnosed with T1D, DKA likely reflects a more rapid immune‐mediated destruction of β‐cells, leading to a functional impairment and a more unstable metabolic state . Although our data showed that occurrence of PREM is comparatively more important than DKA at diagnosis for later metabolic control, DKA is a potentially modifiable risk factor.…”

Section: Discussionsupporting

confidence: 90%

“…Rates of PREM obtained from pediatric cohorts have been reported between 35% and 70%, occurring within 3 months after T1D diagnosis . In our study, the percentage of patients in PREM 3 months after new‐onset T1D was approximately 40%, being at the lower end of the spectrum.…”

Section: Discussionmentioning

confidence: 46%

“…Several studies have shown that the rates of PREM are considerably lower in younger children, reflecting a more rapid autoimmune destruction and a less functional β‐cell mass compared with older patients . Of note, in a retrospective review of young patients with new‐onset T1D, none of the children younger than 3.5 years of age experienced a remission phase .…”

Section: Discussionmentioning

confidence: 99%

“…Patients with new onset type 1 diabetes (T1D) often experience a partial and temporary recovery in pancreatic β‐cell function after both exogenous insulin is started, and chronic hyperglycaemia is corrected . This phenomenon is referred to as “partial remission” (PREM) or “honeymoon” phase, and has been described in up to 70% of pediatric patients in some cohorts shortly after T1D diagnosis . A simple and practical definition of PREM was provided by Mortensen et al and designated as the “insulin dose‐adjusted HbA1c” (IDAA1c), which accounts for insulin dose as well as glycemic control.…”

Section: Introductionmentioning

confidence: 99%

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Partial remission in type 1 diabetes and associated factors: Analysis based on the insulin dose‐adjusted hemoglobin A1c in children and adolescents from a regional diabetes center, Auckland, New Zealand

et al. 2019

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Background Partial remission (PREM) by the insulin dose‐adjusted HbA1c (IDAA1c) method has not been evaluated for the combined associations of ethnicity and socioeconomic status in children and adolescents with type 1 diabetes (T1D). Objective To investigate prevalence and predictors of PREM defined by IDAA1c. Methods Six hundred fourteen of 678 children (aged <15 years) with new‐onset T1D (2000‐2013) from a regional pediatric diabetes service (Auckland, New Zealand). Results Overall rate of PREM at 3 months was 42.4%, and lower in Māori/Pacific children (28.6%; P = .006) and those of other ethnicities (28.8%; P = .030) compared with New Zealand Europeans (50.4%). Comparing the most and least deprived socioeconomic quintiles, the odds of PREM were lower among the most deprived (adjusted odds ratio [aOR] 0.44; P = .019). Lower rates of PREM were seen in children aged 0 to 4.9 years (23.8%) and 10 to 14 years (40.9%) than in children aged 5 to 9.9 years (57.4%; P < .05). Further predictors of lower rates of PREM were ketoacidosis at diagnosis (aOR 0.54 with DKA; P = .002) and diabetes duration (aOR 0.84 per month; P < .0001). Patient's sex, body mass index standard deviation score, or autoantibodies were not associated with PREM. PREM at 3 months was associated with lower HbA1c over 18 months compared with children not in PREM (65.0 vs 71.3 mmol/mol; P < .0001), independent of ketoacidosis. Conclusions This study on a regional cohort of youth with T1D showed social and ethnic disparities in rates of PREM defined by IDAA1c. Further research into reducing ketoacidosis rates at diagnosis and addressing factors associated with lower rates of PREM in non‐European children are important health priorities.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Partial remission in type 1 diabetes and associated factors: Analysis based on the insulin dose‐adjusted hemoglobin A1c in children and adolescents from a regional diabetes center, Auckland, New Zealand

et al. 2019

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“…This data has been corroborated in similar Korean hospital‐based studies suggesting increasing LADA prevalence in the Korean population (the prevalence ranging from 3.8% to 5.1%) . In other Asian countries, such as Japan and China, LADA prevalence was also recently reported to be similarly increased . However, there have been few studies reporting the titres of anti‐islet autoantibodies and their prognostic implication .…”

Section: Clinical Heterogeneity Of Diabetes In Asian Patients At Adolsupporting

confidence: 70%

Clinical heterogeneity of type 1 diabetes (T1D) found in Asia

Park

Wintergerst

Zhou

2017

Diabetes Metabolism Res

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Diabetes mellitus among young patients in Asia is caused by a complex set of factors. Although type 1 diabetes (T1D) remains the most common form of diabetes in children, the recent unabated increase in obesity has resulted in the emergence of type 2 diabetes (T2D) as a new type of diabetes among adolescents and young adults. In addition to the typical autoimmune type 1 diabetes (T1aD) and T2D patients, there is a variable incidence of cases of non-autoimmune types of T1D associated with insulin deficiency (T1bD). Additional forms have been described, including fulminant T1D (FT1D). Although most diagnoses of T1D are classified as T1aD, fulminant T1D exists as a hyper-acute subtype of T1D that affects older children, without associated autoimmunity. Patient with this rare aetiology of diabetes showed a complete loss of β-cell secretory capacity without evidence of recovery, necessitating long-term treatment with insulin. In addition, latent autoimmune diabetes in adults is a form of autoimmune-mediated diabetes, usually diagnosed during the insulin-dependent stage that follows a non-insulin requiring phase, which can be diagnosed earlier based on anti-islet autoantibody positivity. Some reports discuss T1bD. Others are elaborating on the presence of "atypical T1b diabetes," such as Flatbush diabetes. The prevalence of diabetes mellitus in young adults continues to rise in Asian populations as T2D increases. With improved characterization of patients with diabetes, the range of diabetic subgroups will become even more diverse in the future. Distinguishing T1D, T2D, and other forms of diabetes in young patients is challenging in Asian populations, as the correct diagnosis is clinically important and has implications for prognosis and management. Despite aetiological heterogeneity in the usual clinical setting, early diagnosis and classification of patients with diabetes relying on clinical grounds as well as measuring islet autoantibodies and fasting plasma C-peptide could provide a possible viable method to minimize complications.

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Factors Associated With Diabetic Ketoacidosis at Onset of Type 1 Diabetes Among Pediatric Patients

et al. 2022

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ImportancePresenting with diabetic ketoacidosis (DKA) at onset of type 1 diabetes (T1D) remains a risk. Following a 2011 systematic review, considerable additional articles have been published, and the review required updating.ObjectiveTo evaluate factors associated with DKA at the onset of T1D among pediatric patients.Evidence ReviewIn this systematic review, PubMed, Embase, Scopus, CINAHL, Web of Science, and article reference lists were searched using the population, intervention, comparison, outcome search strategy for primary research studies on DKA and T1D onset among individuals younger than 18 years that were published from January 2011 to November 2021. These studies were combined with a 2011 systematic review on the same topic. Data were pooled using a random-effects model.FindingsA total of 2565 articles were identified; 149 were included, along with 46 from the previous review (total 195 articles). Thirty-eight factors were identified and examined for their association with DKA at T1D onset. Factors associated with increased risk of DKA were younger age at T1D onset (&lt;2 years vs ≥2 years; odds ratio [OR], 3.51; 95% CI, 2.85-4.32; P &lt; .001), belonging to an ethnic minority population (OR, 0.40; 95% CI, 0.21-0.74; P = .004), and family history of T1D (OR, 0.46; 95% CI, 0.37-0.57; P &lt; .001), consistent with the 2011 systematic review. Some factors that were not associated with DKA in the 2011 systematic review were associated with DKA in the present review (eg, delayed diagnosis: OR, 2.27; 95% CI, 1.72-3.01; P &lt; .001). Additional factors associated with risk of DKA among patients with new-onset T1D included participation in screening programs (OR, 0.35; 95% CI, 0.21-0.59; P &lt; .001) and presentation during the COVID-19 pandemic (OR, 2.32; 95% CI, 1.76-3.06; P &lt; .001).Conclusions and RelevanceIn this study, age younger than 2 years at T1D onset, belonging to an ethnic minority population, delayed diagnosis or misdiagnosis, and presenting during the COVID-19 pandemic were associated with increased risk of DKA. Factors associated with decreased risk of DKA included greater knowledge of key signs or symptoms of DKA, such as a family history of T1D or participation in screening programs. Future work should focus on identifying and implementing strategies related to these factors to reduce risk of DKA among new patients with T1D.

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Clinical characteristics of type 1 diabetes mellitus in Taiwanese children aged younger than 6 years: A single-center experience

Cited by 22 publications

References 28 publications

Partial remission in type 1 diabetes and associated factors: Analysis based on the insulin dose‐adjusted hemoglobin A1c in children and adolescents from a regional diabetes center, Auckland, New Zealand

Partial remission in type 1 diabetes and associated factors: Analysis based on the insulin dose‐adjusted hemoglobin A1c in children and adolescents from a regional diabetes center, Auckland, New Zealand

Clinical heterogeneity of type 1 diabetes (T1D) found in Asia

Factors Associated With Diabetic Ketoacidosis at Onset of Type 1 Diabetes Among Pediatric Patients

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