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

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 diagnos...

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Vydáno v:	Pediatric diabetes Ročník 15; číslo 7; s. 494 - 501
Hlavní autoři:	Lundgren, Markus, Sahlin, Åsa, Svensson, Camilla, Carlsson, Annelie, Cedervall, Elisabeth, Jönsson, Björn, Jönsson, Ida, Larsson, Karin, Lernmark, Åke, Neiderud, Jan, Vigård, Tore, Elding Larsson, Helena
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Former Munksgaard John Wiley & Sons A/S 01.11.2014
Témata:	Clinical Medicine Cohort Studies Diabetes Mellitus, Type 1 - blood Diabetes Mellitus, Type 1 - diagnosis Diabetes Mellitus, Type 1 - drug therapy Diabetes Mellitus, Type 1 - genetics diabetic ketoacidosis Diabetic Ketoacidosis - epidemiology Diabetic Ketoacidosis - prevention & control Early Diagnosis Endocrinology and Diabetes Endokrinologi och diabetes Female Follow-Up Studies Genetic Predisposition to Disease Glycated Hemoglobin A - analysis HbA1c Humans Hyperglycemia - prevention & control Hypoglycemia - prevention & control Hypoglycemic Agents - therapeutic use Incidence Infant, Newborn Insulin - therapeutic use Klinisk medicin Longitudinal Studies Male Medical and Health Sciences Medicin och hälsovetenskap Pediatrics Pediatrik Prospective Studies Risk Sweden - epidemiology type 1 diabetes follow-up studies type 1 diabetes diabetic ketoacidosis HbA1c
ISSN:	1399-543X, 1399-5448, 1399-5448
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Shrnutí:	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 2 yr 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 hemoglobin A1c (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 yr 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 2 yr 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.
Bibliografie:	Swedish Research Council - No. 14064 Juvenile Diabetes Research Foundation ArticleID:PEDI12151 SUS foundations Lion Club International istex:7C774A5E2400C40A641DE13D577EA781216B4F09 National Institutes of Health - No. DK26190 Wallenberg Foundation SUS funds district 101-S Terry & Louise Gregg Diabetes in Pregnancy Award from the American Diabetes Association Swedish Childhood Diabetes Foundation Skåne County Council Foundation for Research and Development Swedish Diabetes Association ark:/67375/WNG-K37XWLB7-7 Nordisk Insulin Fund ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1399-543X 1399-5448 1399-5448
DOI:	10.1111/pedi.12151