Factors Associated With the Decline of C-Peptide in a Cohort of Young Children Diagnosed With Type 1 Diabetes

• Published in: The journal of clinical endocrinology and metabolism Vol. 106; no. 3; pp. e1380 - e1388
• Main Authors: Steck, Andrea K, Liu, Xiang, Krischer, Jeffrey P, Haller, Michael J, Veijola, Riitta, Lundgren, Markus, Ahmed, Simi, Akolkar, Beena, Toppari, Jorma, Hagopian, William A, Rewers, Marian J, Elding Larsson, Helena
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 08.03.2021; Copyright Oxford University Press
• Subjects: Adolescent; Age; Age of Onset; Alefacept; Analysis; Antithymocyte globulin; Autoantibodies; Autoantibodies - blood; Autoimmunity; beta cell decline; Body mass index; C-peptide; C-Peptide - blood; Care and treatment; Case-Control Studies; Child; Child, Preschool; Children; Clinical Medicine; Clinical s; Cohort Studies; Diabetes; Diabetes mellitus (insulin dependent); Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - diagnosis; Diabetes Mellitus, Type 1 - epidemiology; Diabetes therapy; Diagnosis; Disease Progression; Down-Regulation; Endocrinology and Diabetes; Endokrinologi och diabetes; Female; Females; Follow-Up Studies; Health aspects; Humans; Infant; Klinisk medicin; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Multivariate analysis; new onset; pediatric type 1 diabetes; Pediatrics; Pediatrik; Peptides; Risk factors; Sex; Standard scores; Type 1 diabetes; Weight; Florida; Maryland; Germany; Finland; pediatric type 1 diabetes; risk factors; new onset; beta cell decline; C-peptide
• ISSN: 0021-972X; 1945-7197; 1945-7197
• DOI: 10.1210/clinem/dgaa715

Abstract Context Understanding factors involved in the rate of C-peptide decline is needed to tailor therapies for type 1 diabetes (T1D). Objective Evaluate factors associated with rate of C-peptide decline after a T1D diagnosis in young children. Design Observational study. Setting Academic centers. Participants A total of 57 participants from the Environmental Determinants of Diabetes in the Young (TEDDY) study who were enrolled at 3 months of age and followed until T1D, and 56 age-matched children diagnosed with T1D in the community. Intervention A mixed meal tolerance test was used to measure the area under the curve (AUC) C-peptide at 1, 3, 6, 12, and 24 months postdiagnosis. Outcome Factors associated with rate of C-peptide decline during the first 2 years postdiagnosis were evaluated using mixed effects models, adjusting for age at diagnosis and baseline C-peptide. Results Adjusted slopes of AUC C-peptide decline did not differ between TEDDY subjects and community controls (P = 0.21), although the former had higher C-peptide baseline levels. In univariate analyses combining both groups (n = 113), younger age, higher weight and body mass index z-scores, female sex, an increased number increased number of islet autoantibodies, and IA-2A or ZnT8A positivity at baseline were associated with a higher rate of C-peptide loss. Younger age, female sex, and higher weight z-score remained significant in multivariate analysis (all P < 0.02). At 3 months after diagnosis, higher HbA1c became an additional independent factor associated with a higher rate of C-peptide decline (P < 0.01). Conclusion Younger age at diagnosis, female sex, higher weight z-score, and HbA1c were associated with a higher rate of C-peptide decline after T1D diagnosis in young children.