Permanent diabetes mellitus in the first year of life.
OBJECTIVE
The pathogenesis of permanent diabetes mellitus diagnosed early in life is heterogeneous and, in most cases, not known. We aimed at identifying markers differentiating between non-autoimmune and autoimmune diabetes.


METHODS
The clinical, genetic and epidemiological features of 111 diabetic patients (62 males) who received insulin within 12 months of life were studied.


RESULTS
The epidemic curve by age of diabetes onset revealed two subsets of patients at a cutoff of 180 days. In the group with diabetes onset before 180 days ("early onset" permanent diabetes) the analysis of HLA susceptibility heterodimers (available for 21 individuals) showed that 76% had a "protective" HLA genotype for Type I (insulin-dependent) diabetes mellitus as compared to 11.9% (5/42) of the later onset group. Accordingly, "early onset" children were less likely to have autoimmunity markers (4 out of 26 tested) than children with onset after 180 days (13 out 20 tested) (15.4% vs. 65.0%, p<0.01). Of note, 19 out of 20 (or the 95%) patients who were born on the island of Sardinia, an Italian region where the incidence of Type I diabetes is six times higher than continental Italy (33/100,000/year vs 5/100,000/year), were included in the later onset group (>180 days). Small-for-date birthweight, a possible sign of reduced foetal insulin secretion, was more common in the "early onset" group (OR=9.9, 95%-CI 2.6-38.6).


CONCLUSIONS
These results, obtained in the largest population-based cohort of diabetic infants hitherto reported, suggest that "early onset" permanent diabetes cases differ from later onset cases and that most of them do not have an autoimmune pathogenesis.
Iafusco
D
D
Department of Paediatrics, Second University of Naples, Via S. Andrea delle Dame n 4 - 80100 Napoli, Italy. dario.iafusco@unina2.it
Stazi
M A
MA
Cotichini
R
R
Cotellessa
M
M
Martinucci
M E
ME
Mazzella
M
M
Cherubini
V
V
Barbetti
F
F
Martinetti
M
M
Cerutti
F
F
Prisco
F
F
D017668:Age of Onset; D001323:Autoantibodies / Q000097:blood; D001724:Birth Weight; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use*; D007515:Islets of Langerhans / Q000276:immunology; D007558:Italy / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D012621:Seasons
D001323:Autoantibodies; D007328:Insulin; C024211:islet cell antibody