Clinical evolution of beta cell function in youth with diabetes: the SEARCH for Diabetes in Youth study
Few studies have explored the epidemiology of beta cell loss in youth with diabetes. This report describes the evolution and major determinants of beta cell function, assessed by fasting C-peptide (FCP), in the SEARCH for Diabetes in Youth study.
Participants were 1,277 youth with diabetes (948 positive for diabetes autoantibodies [DAs] and 329 negative for DAs), diagnosed when aged <20 years, who were followed from a median of 8 months post diagnosis, for approximately 30 months. We modelled the relationship between rate of change in log FCP and determinants of interest using repeated measures general linear models.
Among DA-positive youth, there was a progressive decline in beta cell function of 4% per month, independent of demographics (age, sex, race/ethnicity), genetic susceptibility to autoimmunity (HLA risk), HbA1c and BMI z score, or presence of insulin resistance. Among DA-negative youth, there was marked heterogeneity in beta cell loss, reflecting an aetiologically mixed group. This group likely includes youths with undetected autoimmunity (whose decline is similar to that of DA-positive youth) and youth with non-autoimmune, insulin-resistant diabetes, with limited decline (~0.7% per month).
SEARCH provides unique estimates of beta cell function decline in a large sample of youth with diabetes, indicating that autoimmunity is the major contributor. These data contribute to a better understanding of clinical evolution of beta cell function in youth with diabetes, provide strong support for the aetiological classification of diabetes type and may inform tertiary prevention efforts targeted at high-risk groups.
- Clinical evolution of beta cell function in youth with diabetes: the SEARCH for Diabetes in Youth study
Volume 55, Issue 12 , pp 3359-3368
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- Beta cell function
- Type 1 diabetes
- Type 2 diabetes
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- Author Affiliations
- 1. Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, 13001 East 17th Ave, Box B119, Aurora, CO, 80045, USA
- 2. Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill, NC, USA
- 3. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston Salem, NC, USA
- 4. Department of Pediatrics, Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- 5. Department of Pediatrics, University of Washington, Seattle, WA, USA
- 6. Diabetes Research Program, Benaroya Research Institute, Seattle, WA, USA
- 7. Department of Medicine, University of Washington, Seattle, WA, USA
- 8. Kuakini Medical Center, Honolulu, HI, USA
- 9. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
- 10. Division of Diabetes Translation, Centers for Diseases Control and Prevention, Atlanta, GA, USA