Reduced morbidity at diagnosis and improved glycemic control in children previously enrolled in DiPiS follow-up

Abstract

Aims/hypothesis Children participating in longitudinal type 1 diabetes prediction studies were reported to have less severe disease at diabetes diagnosis. Our aim was to investigate children who from birth participated in the Diabetes Prediction in Skåne (DiPiS) study for metabolic status at diagnosis and then continued to be followed for two years of regular clinical care. Methods Children, followed in DiPiS before diagnosis, were compared to children in the same birth cohort who did not participate in follow-up. Metabolic status, symptoms at diagnosis as well as HbA1c and doses of insulin at 3, 6, 12 and 24 months after diagnosis were compared. Results Children, followed in DiPiS and diagnosed at 2–12 years of age, had 0.8% (9 mmol/mol) lower HbA1c at diagnosis than those who were not followed (p=0.006). At diagnosis, fewer DiPiS children had symptoms (p=0.014) and ketoacidosis at diagnosis were reduced (2% compared to 18%, p=0.005). During regular clinical care, HbA1c levels for the DiPiS children remained lower both at 12 (0.4% (4 mmol/mol); p=0.009) and 24 months (0.8% (9 mmol/mol) p <0.001) after diagnosis, despite no difference in total daily insulin between the two groups. Conclusions Participation in prospective follow-up before diagnosis of type 1 diabetes leads to earlier diagnosis with fewer symptoms, decreased incidence of ketoacidosis as well as better metabolic control up to two years after diagnosis. Our data indicate that metabolic control at the time of diabetes diagnosis is important for early metabolic control possibly affecting the risk of long-term complications.

Effect of screening for type 1 diabetes on early metabolic control: the DiPiS study

“…Children who developed two or more islet autoantibodies were offered follow-up every 3 months with autoantibody sampling, HbA 1c , random plasma glucose and yearly oral glucose tolerance tests [6]. Children in follow-up were informed of risk after each blood sampling.…”

“…We have previously described improved metabolic status at diagnosis and the 2 years after diagnosis for study participants [6]. The aim of this study was to examine whether the positive effect on metabolic control remains after the cohort has reached 5 years after diabetes diagnosis.…”

Residual beta-cell function in diabetes children followed and diagnosed in the TEDDY study compared to community controls

“…However, those favorable patterns of IDAA1c and C‐peptide were no longer apparent 1 year from diagnosis. Children followed before diabetes diagnosis within the DiPiS study had a lower HbA1c up to 2 years after diagnosis, compared with children diagnosed from the community . In the T1D Exchange Clinic Network, the overall frequency of detectable non‐fasting C‐peptide was 29%, with higher frequency in those diagnosed above age 18; residual secretion was present in almost 1 of 3 individuals 3 or more years from diabetes diagnosis …”

Building and validating a prediction model for paediatric type 1 diabetes risk using next generation targeted sequencing of class II HLA genes

“…There are reports that children diagnosed with beta‐cell autoantibodies in longitudinal studies, in comparison with those in the community, required no or fewer hospitalizations, or had reduced frequency of ketoacidosis after being diagnosed . It has also been reported that participation in prospective follow‐up before diagnosis of T1D leads to earlier diagnosis with fewer symptoms, decreased incidence of ketoacidosis, as well as better metabolic control up to 2 years after diagnosis . Also, it cannot be excluded that several secondary prevention studies initially failing the end‐point such as parenteral and oral insulin in DPT‐1, nicotinamide in ENDIT, nasal insulin in DIPP, or hydrolyzed infant formula in TRIGR eventually may be successful perhaps through primary prevention or more effective intervention studies .…”