title: Down's syndrome in diabetic patients aged <20 years: an analysis of metabolic status, glycaemic control and autoimmunity in comparison with type 1 diabetes.
abstract: OBJECTIVE
  Intellectual impairment in individuals with Down's syndrome and diabetes mellitus potentially limits the quality of diabetic control. In addition, these patients are at risk of having immunological abnormalities. The present study compared metabolic status and concomitant diseases in young (<20 years old) Down's syndrome patients with diabetes vs young type 1 diabetic patients.
  
  
  METHODS
  The Diabetes-Patienten-Verlaufsdaten is a longitudinal follow-up database, which collects data from 298 German and Austrian diabetes centres. Data available on diabetic patients aged <20 years were analysed statistically.
  
  
  RESULTS
  We compared data for 159 Down's syndrome patients with diabetes and 41,983 type 1 diabetic patients. The former used less insulin, but showed better glycaemic control (HbA1c). Diabetes onset during the first 3 years of life occurred in 18.9% of Down's syndrome patients with diabetes and in 6.4% of type 1 diabetic patients. Antibody titres indicative of coeliac disease and thyroid peroxidase antibodies were more frequent in Down's syndrome patients with diabetes. No significant differences were found regarding the beta cell autoantibodies studied.
  
  
  CONCLUSIONS
  The age-of-onset distribution showed a shift towards younger ages and was bimodal in the Down's syndrome group. The better metabolic control found, despite intellectual impairment, in young Down's syndrome patients with diabetes cannot be conclusively explained by our data, but is likely to be due to a less complex lifestyle. Our data provide further confirmation that coeliac and thyroid antibodies are more prevalent in Down's syndrome. The presence of beta cell autoantibodies supports an autoimmune cause of diabetes in some children with Down's syndrome.
authors.affiliation: Department of Paediatrics and Neonatology, Saarland University Hospital, Kirrberger Str. 1, Geb. 9, 66421 Homburg/Saar, Germany. tilman.rohrer@uniklinikum-saarland.de
authors.forename: T R
authors.initials: TR
authors.lastname: Rohrer
authors.forename: P
authors.initials: P
authors.lastname: Hennes
authors.forename: A
authors.initials: A
authors.lastname: Thon
authors.forename: A
authors.initials: A
authors.lastname: Dost
authors.forename: M
authors.initials: M
authors.lastname: Grabert
authors.forename: B
authors.initials: B
authors.lastname: Rami
authors.forename: S
authors.initials: S
authors.lastname: Wiegand
authors.forename: R W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D017668:Age of Onset; D001323:Autoantibodies / Q000276:immunology; D015551:Autoimmunity / Q000276:immunology*; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D016208:Databases, Factual; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000276:immunology / Q000378:metabolism* / Q000628:therapy; D004314:Down Syndrome / Q000150:complications* / Q000276:immunology / Q000378:metabolism*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D012044:Regression Analysis; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin