title: The severity of clinical presentation of type 1 diabetes in children does not significantly influence the pattern of residual beta-cell function and long-term metabolic control.
abstract: OBJECTIVE
  The purpose of the present study was to compare relationships between the clinical presentation of type 1 diabetes in children and residual beta-cell secretion and long-term metabolic control.
  
  
  METHODS
  This retrospective study was conducted in 66 diabetic children with age at diagnosis ranging from 0.7 to 14.8 yr. The patients showed contrasting characteristics at diagnosis: either diabetic ketoacidosis (DKA) (group 1, n = 29) or absence of metabolic derangement (group 2, n = 37) associated with marked (group 2A, n = 12) or mild hyperglycemia (group 2B, n = 25). A regular follow-up was available for at least 10 yr (10-32 yr) in all cases and for 20 yr in 23 cases. C-peptide levels were measured from diagnosis and thereafter at intervals for the first years of disease until becoming permanently undetectable.
  
  
  RESULTS
  C-peptide levels at diagnosis were undetectable in about 20% of the cases both with and without DKA. C-peptide levels at diagnosis, the duration of measurable C-peptide levels and the maximum value found during follow-up were not significantly different in the three groups and were not correlated with glycated hemoglobin (GHb) calculated throughout the whole period. No differences were found between the groups of patients concerning GHb values and insulin dose at 10, 15 and 20 yr of disease. The patients of group 2A, characterized by an extremely high glycemic level without ketoacidosis, had a significantly higher prevalence of HLA DR3/4 heterozygosity.
  
  
  CONCLUSIONS
  The severity of clinical presentation at diagnosis does not significantly influence residual beta-cell function, and long-term metabolic control.
authors.affiliation: Department of Pediatrics, University of Bologna, 40138 Bologna, Italy. salardi@med.unibo.it
authors.forename: Silvana
authors.initials: S
authors.lastname: Salardi
authors.forename: Stefano
authors.initials: S
authors.lastname: Zucchini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cicognani
authors.forename: Elena
authors.initials: E
authors.lastname: Corbelli
authors.forename: Roberta
authors.initials: R
authors.lastname: Santoni
authors.forename: Luca
authors.initials: L
authors.lastname: Ragni
authors.forename: Daniela
authors.initials: D
authors.lastname: Elleri
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cacciari
mesh_terms: D000293:Adolescent; D000328:Adult; D001769:Blood; D001786:Blood Glucose / Q000032:analysis*; D002096:C-Peptide / Q000097:blood; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D016883:Diabetic Ketoacidosis / Q000175:diagnosis; D006442:Glycated Hemoglobin / Q000032:analysis; D015803:HLA-DR3 Antigen / Q000235:genetics; D015804:HLA-DR4 Antigen / Q000235:genetics; D006579:Heterozygote; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006943:Hyperglycemia / Q000175:diagnosis; D007515:Islets of Langerhans / Q000503:physiopathology*; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D015803:HLA-DR3 Antigen; D015804:HLA-DR4 Antigen