Location: Children's Nutrition Research CenterTitle: Racial and ethnic differences among children with new-onset autoimmune type 1 diabetes
|Gandhi, Kajal - Baylor College Of Medicine|
|Tosur, Mustafa - Baylor College Of Medicine|
|Schaub, Rebecca - Baylor College Of Medicine|
|Haymond, Morey - Children'S Nutrition Research Center (CNRC)|
|Redondo, Maria - Baylor College Of Medicine|
Submitted to: Diabetic Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/13/2017
Publication Date: 7/13/2017
Citation: Gandhi, K., Tosur, M., Schaub, R., Haymond, M.W., Redondo, M.J. 2017. Racial and ethnic differences among children with new-onset autoimmune type 1 diabetes. Diabetic Medicine. 34:1435–1439. http://dx.doi.org/10.1111/dme.13408.
Interpretive Summary: As more and more research is carried out, it becomes apparent that there may be many causes for the clinical presentation of a single disease entity. This then leads us to explore differences (or commonalities) in the causal factors of a disease in different groups of patients. Such is the case with type 1 diabetes mellitus. We analyzed data on over 600 children with new onset type 1 diabetes at Texas Children's Hospital (Houston, Texas) comparing patient ethnic impact on clinical and laboratory findings. We found that at the onset of autoimmune Type 1 diabetes in children, Hispanic, but not African-American children showed evidence of more resistance to insulin. These findings suggest that ethnicity may contribute to the different factors that might be linked to the cause of Type 1 diabetes.
Technical Abstract: To compare demographic and clinical characteristics among children from ethnic minorities and non-Hispanic white children with new-onset autoimmune Type 1 diabetes. We analyzed a single-center series of 712 children with new-onset autoimmune Type 1 diabetes between January 2008 and March 2011. The median (range) age was 9.7 (0.3–18.1) years, the mean (SD) BMI percentile was 69.7 (25.4) and 48.3% of the cohort were girls. The cohort comprised 57.3% non-Hispanic white, 20.5% Hispanic and 14.8% African-American children, and 7.4% were of other, mixed or unknown race. The Hispanic subgroup, compared with non-Hispanic white subgroup, had a higher mean (SD) C-peptide level [0.82 (1.62) vs 0.55 (0.47) ng/ml; P=0.004), and a greater proportion of children with elevated BMI (overweight or obesity; 49.6% vs 32.5%; P<0.001) and diabetic ketoacidosis (51.8% vs 38.2%; P=0.006). The African-American group had a higher mean (SD) glucose level [24.4 (12.8) vs 21.4 (10.7) mmol/l; P=0.017], a greater proportion of children with ketoacidosis (56.7% vs 38.2%; P=0.001), a greater proportion with elevated BMI (52.9% vs 32.5%; P<0.001), and a lower proportion of children at pre-pubertal stage (49.0% vs 61.6%; P=0.01), and tended to have higher C-peptide levels [0.65 (0.59) vs 0.55 [0.47] ng/ml; P=0.079) compared with the non-Hispanic white children. The differences in Cpeptide levels compared with non-Hispanic white children persisted for Hispanic (P=0.01) but not African-American children (P=0.29) after adjustment for age, sex, BMI, ketoacidosis, glucose, Tanner stage and autoantibody number. At the onset of paediatric autoimmune Type 1 diabetes, Hispanic, but not African-American children had higher C-peptide levels, after adjustment for potential confounders, compared with non-Hispanic white children. These findings suggest that ethnicity may contribute to the heterogeneity of Type 1 diabetes Pathogenesis, with possible implications for intervention.