Clinical characteristics of children diagnosed with type 1 diabetes through intensive screening and follow-up.
OBJECTIVE
The objective of this study was to determine whether earlier diagnosis of diabetes in prospectively followed autoantibody-positive children lowered onset morbidity and improved the clinical course after diagnosis.


METHODS
The Diabetes Autoimmunity Study in the Young (DAISY) follows genetically at-risk children for the development of diabetes. Increased genetic risk is identified by family history of type 1 diabetes or expression of diabetes-associated HLA genotypes. Of the 2,140 prospectively followed children, 112 have developed islet autoantibodies and 30 have progressed to diabetes. Diabetes onset characteristics and early clinical course of these 30 children followed to diabetes were compared with those of 101 age- and sex-matched children concurrently diagnosed with diabetes in the community.


RESULTS
Pre-diabetic children followed to diabetes were less often hospitalized than the community cases (3.3 vs. 44%; P < 0.0001). They had a lower mean HbA(1c) at onset (7.2 vs. 10.9%; P < 0.0001) and 1 month after diagnosis (6.9 vs. 8.6%; P < 0.0001) but not after 6 months of diabetes. The mean insulin dose was lower in the DAISY group at 1 (0.30 vs. 0.51 U. kg(-1). day(-1); P = 0.003), 6 (0.37 vs. 0.58; P = 0.001), and 12 months (0.57 vs. 0.72; P = 0.03). There was no difference in growth parameters between the two groups. Comparisons limited to children with a family history of type 1 diabetes in both groups showed a similar pattern.


CONCLUSIONS
Childhood type 1 diabetes diagnosed through a screening and follow-up program has a less severe onset and a milder clinical course in the first year after diagnosis.
Barker
Jennifer M
JM
Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, 4200 East Ninth Ave., Box B140, Denver, CO 80262. jennifer.barker@uchsc.edu
Goehrig
Stephanie H
SH
Barriga
Katherine
K
Hoffman
Michelle
M
Slover
Robert
R
Eisenbarth
George S
GS
Norris
Jill M
JM
Klingensmith
Georgeanna J
GJ
Rewers
Marian
M
D001323:Autoantibodies / Q000097:blood*; D002648:Child; D003120:Colorado; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology*; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008403:Mass Screening / Q000592:standards*; D011236:Prediabetic State / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology*; D016896:Treatment Outcome
D001323:Autoantibodies