title: Residual beta-cell function in diabetes children followed and diagnosed in the TEDDY study compared to community controls.
abstract: OBJECTIVE
  To explore whether children diagnosed with type 1 diabetes during islet autoantibody surveillance through The Environmental Determinants of Diabetes in the Young (TEDDY) study retain greater islet function than children diagnosed through the community.
  
  
  METHODS
  TEDDY children identified at birth with high-risk human leukocyte antigen and followed every 3 months until diabetes diagnosis were compared to age-matched children diagnosed with diabetes in the community. Both participated in long-term follow up after diagnosis. Hemoglobin A1c (HbA1c) and mixed meal tolerance test were performed within 1 month of diabetes onset, then at 3, 6, and 12 months, and biannually thereafter.
  
  
  RESULTS
  Comparison of 43 TEDDY and 43 paired control children showed that TEDDY children often had no symptoms (58%) at diagnosis and none had diabetic ketoacidosis (DKA) compared with 98% with diabetes symptoms and 14% DKA in the controls (P < 0.001 and P = 0.03, respectively). At diagnosis, mean HbA1c was lower in TEDDY (6.8%, 51 mmol/mol) than control (10.5%, 91 mmol/mol) children (P < 0.0001). TEDDY children had significantly higher area under the curve and peak C-peptide values than the community controls throughout the first year postdiagnosis. Total insulin dose and insulin dose-adjusted A1c were lower throughout the first year postdiagnosis for TEDDY compared with control children.
  
  
  CONCLUSIONS
  Higher C-peptide levels in TEDDY vs community-diagnosed children persist for at least 12 months following diabetes onset and appear to represent a shift in the disease process of about 6 months. Symptom-free diagnosis, reduction of DKA, and the potential for immune intervention with increased baseline C-peptide may portend additional long-term benefits of early diagnosis.
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Steck
authors.affiliation: Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
authors.forename: Helena Elding
authors.initials: HE
authors.lastname: Larsson
authors.affiliation: Health Informatics Institute, University of South Florida, Tampa, Florida.
authors.forename: Xiang
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Pediatrics, PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
authors.forename: Riitta
authors.initials: R
authors.lastname: Veijola
authors.affiliation: Turku Department of Physiology, Institute of Biomedicine, University of Turku, Turku, Finland.|Department of Pediatrics, Turku University Hospital, Turku, Finland.
authors.forename: Jorma
authors.initials: J
authors.lastname: Toppari
authors.affiliation: Pacific Northwest Diabetes Research Institute, University of Washington, Seattle, WA.
authors.forename: William A
authors.initials: WA
authors.lastname: Hagopian
authors.affiliation: Department of Pediatrics, University of Florida, Gainesville, Florida.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Haller
authors.affiliation: Immunology of T1D, JDRF International, New York, New York.
authors.forename: Simi
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Division of Diabetes, Endocrinology & Metabolism, National Institute of Diabetes, Digestive, & Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: Beena
authors.initials: B
authors.lastname: Akolkar
authors.affiliation: Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.
authors.forename: Åke
authors.initials: Å
authors.lastname: Lernmark
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Marian J
authors.initials: MJ
authors.lastname: Rewers
authors.affiliation: Health Informatics Institute, University of South Florida, Tampa, Florida.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Krischer
mesh_terms: D002096:C-Peptide / Q000097:blood*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D050417:Insulin-Secreting Cells / Q000378:metabolism; D008297:Male; D011159:Population Surveillance; D011446:Prospective Studies
chemical_list: D002096:C-Peptide; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: 
  HbA1c
  ; pediatric diabetes; preservation of C-peptide; prospective study; type 1 diabetes