Ann Pediatr Endocrinol Metab.  2022 Jun;27(2):121-125. 10.6065/apem.2142170.085.

Demographic and diagnostic markers in new onset pediatric type 1 and type 2 diabetes: differences and overlaps

• Nieto T
• Castillo B
• Nieto J
• Redondo MJ

• KMID: 2531276
• DOI: http://doi.org/10.6065/apem.2142170.085

Abstract

Purpose
Type 1 diabetes (T1D) is the most common type of diabetes in children, but the frequency of type 2 diabetes (T2D) is increasing rapidly. Classification of diabetes is based on a constellation of features that vary by type. We aimed to compare demographic, clinical, and laboratory characteristics at diagnosis of pediatric T1D and T2D.
Methods
We studied children who visited a large academic hospital in Houston, Texas (USA) with a new diagnosis of T2D (n=753) or T1D (n=758). We compared age, sex, race/ethnicity, presence of obesity, glucose, hemoglobin A1c, islet autoantibody positivity, C-peptide, and presence of diabetic ketoacidosis (DKA) at diabetes diagnosis.
Results
At diagnosis, children with T2D, compared with those with T1D, were older (13.6 years vs. 9.7 years), more likely female (63.2% vs. 47.8%), of racial/ethnic minority (91.1% vs. 42.3%), and obese (90.9% vs. 19.4%) and were less likely to have DKA (7.8% vs. 35.0%) and diabetes autoantibodies (5.5% vs. 95.4%). Children with T2D also had significantly lower glucose, lower hemoglobin A1c and lower C-peptide level (all comparisons, p<0.0001). In multiple logistic regression analysis, older age, racial/ethnic minority, obesity, higher C-peptide, and negative islet autoantibodies were independently associated with T2D (all, p<0.05), while sex, glucose, hemoglobin A1c, and DKA were not (model p<0.0001).
Conclusion
There are important demographic, clinical, and laboratory differences between T1D and T2D in children. However, none of the characteristics were unique to either diabetes type, which poses challenges to diabetes classification at diagnosis.

Keyword

Type 1 diabetes; Type 2 diabetes; Pediatric; Diagnosis; Overlap; Classification; Autoimmunity; Metabolic; Demographic; Heterogeneity

Figure

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  Fig. 1. Histograms illustrating the distributions of age (A), glucose (B), hemoglobin A1c (C), and C-peptide (D) at diagnosis, by diabetes type. The ranges for age were 0.66–18.1 years for T1D and 6.0–18.9 years for T2D; for glucose, 63–1967 mg/dL for T1D and 66–1,213 mg/dL for T2D; for hemoglobin A1c, 5%–15% for T1D and 5.1%–15% for T2D; and for C-peptide, 0.04–18 ng/mL for T1D and 0.12–45.9 ng/mL for T2D. In each of the graphs, T1D is shown in blue and T2D is shown in orange. T1D, type 1 diabetes; T2D, type 2 diabetes.

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  Fig. 2. Comparison of characteristics in children with T1D and T2D at diagnosis (all, P<0.0001). Continuous variables were dichotomized using the mean value of the distribution in the combined cohort, rounded to the closest whole number. T1D is shown in blue and T2D is shown in orange. T1D, type 1 diabetes; T2D, type 2 diabetes; A1c, hemoglobin A1c; DKA, diabetic ketoacidosis; Ab, Islet autoantibodies.

Reference

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