Distinguishing Type 2 Diabetes from Type 1 Diabetes in African American and Hispanic American Pediatric Patients

• Published in: PLoS ONE Vol. 7; no. 3; p. e32773
• Main Authors: Keller, Nancy, Bhatia, Suruchi, Braden, Jeanah N, Gildengorin, Ginny, Johnson, Jameel, Yedlin, Rachel, Tseng, Teresa, Knapp, Jacquelyn, Glaser, Nicole, Jossan, Paula, Teran, Shawn, Rhodes, Erinn T, Noble, Janelle A
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science (PLoS) 07.03.2012; Public Library of Science
• Subjects: Adolescent; African Americans; Age; Age of Onset; Analysis; Asian people; Asians; Biomedical and Clinical Sciences; Black or African American; Body mass; Body Mass Index; Child; Child health; Child, Preschool; Children & youth; Clinical Sciences; Diabetes; Diabetes Mellitus; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 1 - diagnosis; Diabetes Mellitus, Type 1 - ethnology; Diabetes Mellitus, Type 2; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - ethnology; Diagnosis; Diagnosis, Differential; Differential; Endocrinology; Fatty acids; Female; Females; General Science & Technology; Glucose; Glycated Hemoglobin; Glycated Hemoglobin A - analysis; Glycosylated hemoglobin; Health Sciences; Hemoglobin; Hispanic Americans; Hispanic or Latino; Humans; Insulin; Male; Males; Medical records; Medicine; Metabolic and endocrine; Metabolic syndrome; Minority & ethnic groups; Obesity; Patients; Pediatric; Pediatrics; Preschool; Preschool children; Prognosis; Q; R; Race; Regression Analysis; Regression models; Research Article; Risk; ROC Curve; Science; Sensitivity; Sensitivity analysis; Sex Factors; Social and Behavioral Sciences; Studies; Teenagers; Type 1; Type 1 diabetes; Type 2; Type 2 diabetes; Sacramento California; California; United States > US; Texas; Massachusetts
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0032773

To test the hypothesis that clinical observations made at patient presentation can distinguish type 2 diabetes (T2D) from type 1 diabetes (T1D) in pediatric patients aged 2 to 18. Medical records of 227 African American and 112 Hispanic American pediatric patients diagnosed as T1D or T2D were examined to compare parameters in the two diseases. Age at presentation, BMI z-score, and gender were the variables used in logistic regression analysis to create models for T2D prediction. The regression-based model created from African American data had a sensitivity of 92% and a specificity of 89%; testing of a replication cohort showed 91% sensitivity and 93% specificity. A model based on the Hispanic American data showed 92% sensitivity and 90% specificity. Similarities between African American and Hispanic American patients include: (1) age at onset for both T1D and T2D decreased from the 1980s to the 2000s; (2) risk of T2D increased markedly with obesity. Racial/ethnic-specific observations included: (1) in African American patients, the proportion of females was significantly higher than that of males for T2D compared to T1D (p<0.0001); (2) in Hispanic Americans, the level of glycated hemoglobin (HbA1c) was significantly higher in T1D than in T2D (p<0.002) at presentation; (3) the strongest contributor to T2D risk was female gender in African Americans, while the strongest contributor to T2D risk was BMI z-score in Hispanic Americans. Distinction of T2D from T1D at patient presentation was possible with good sensitivity and specificity using only three easily-assessed variables: age, gender, and BMI z-score. In African American pediatric diabetes patients, gender was the strongest predictor of T2D, while in Hispanic patients, BMI z-score was the strongest predictor. This suggests that race/ethnic specific models may be useful to optimize distinction of T1D from T2D at presentation.