title: Comparison of Metabolic Outcomes in Children Diagnosed with Type 1 Diabetes Through Research Screening (Diabetes Autoimmunity Study in the Young [DAISY]) Versus in the Community.
abstract: BACKGROUND
  Children with positive islet autoantibodies monitored prospectively avoid metabolic decompensation at type 1 diabetes (T1D) diagnosis. However, the effects of early diagnosis and treatment on preservation of insulin secretion and long-term metabolic control are unknown. We compared characteristics of children detected through research screening (Diabetes Autoimmunity Study in the Young [DAISY]) versus community controls at baseline and, in a subset, 6- and 12-month metabolic outcomes.
  
  
  METHODS
  This was a case-control study comparing DAISY children with T1D to children diagnosed in the general community. All participants underwent mixed-meal tolerance testing; a subset wore a continuous glucose monitoring (CGM) device. Fasting and stimulated C-peptide levels, insulin dose-adjusted hemoglobin A1c (IDAA1c), and CGM variables were compared.
  
  
  RESULTS
  Children (21 DAISY, 21 community) were enrolled and matched by age, time of diagnosis, and diabetes duration; 18 were enrolled within 2 months and 24 within 2.5 years on average from diagnosis. In the overall group and the subgroup of participants enrolled 2.5 years from diagnosis, there were no IDAA1c or C-peptide differences between DAISY versus community children. The subgroup of DAISY versus community children enrolled near diagnosis, however, had lower baseline hemoglobin A1c (6.5±1.4% vs. 9.2±2.9%; P=0.0007) and IDAA1c (7.4±2.1% vs. 11.2±3.5%; P=0.04) and higher stimulated C-peptide (2.5±0.5 vs. 1.6±0.2 ng/mL; P=0.02). In this subgroup, IDAA1c differences persisted at 6 months but not at 1 year. CGM analyses revealed lower minimum overnight glycemia in community children (72 vs. 119 mg/dL; P=0.01).
  
  
  CONCLUSIONS
  Favorable patterns of IDAA1c and C-peptide seen in research-screened versus community-diagnosed children with T1D within 2 months of diagnosis are no longer apparent 1 year from diagnosis.
authors: 1 Children's Hospital Colorado and University of Colorado Denver , Aurora, Colorado.
authors: Christine L
authors: CL
authors: Chan
authors: 2 Barbara Davis Center for Childhood Diabetes, University of Colorado Denver , Aurora, Colorado.
authors: Iman
authors: I
authors: Taki
authors: 2 Barbara Davis Center for Childhood Diabetes, University of Colorado Denver , Aurora, Colorado.
authors: Fran
authors: F
authors: Dong
authors: 2 Barbara Davis Center for Childhood Diabetes, University of Colorado Denver , Aurora, Colorado.
authors: Michelle
authors: M
authors: Hoffman
authors: 3 Department of Epidemiology, Colorado School of Public Health, University of Colorado , Aurora, Colorado.
authors: Jill M
authors: JM
authors: Norris
authors: 2 Barbara Davis Center for Childhood Diabetes, University of Colorado Denver , Aurora, Colorado.
authors: Georgeanna
authors: G
authors: Klingensmith
authors: 2 Barbara Davis Center for Childhood Diabetes, University of Colorado Denver , Aurora, Colorado.
authors: Marian J
authors: MJ
authors: Rewers
authors: 2 Barbara Davis Center for Childhood Diabetes, University of Colorado Denver , Aurora, Colorado.
authors: Andrea K
authors: AK
authors: Steck
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D015551:Autoimmunity; D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring / Q000706:statistics & numerical data; D002096:C-Peptide / Q000097:blood*; D016022:Case-Control Studies; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D042241:Early Diagnosis; D005215:Fasting / Q000097:blood; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D008403:Mass Screening / Q000379:methods*; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human