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Relationship between islet autoantibody status and the clinical characteristics of children and adults with incident type 1 diabetes in a UK cohort.
BMJ Open 2018; 8(4):e020904BO

Abstract

OBJECTIVES

To describe the characteristics of children and adults with incident type 1 diabetes in contemporary, multiethnic UK, focusing on differences between the islet autoantibody negative and positive.

DESIGN

Observational cohort study.

SETTING

146 mainly secondary care centres across England and Wales.

PARTICIPANTS

3312 people aged ≥5 years were recruited within 6 months of a clinical diagnosis of type 1 diabetes via the National Institute for Health Research Clinical Research Network. 3021 were of white European ethnicity and 291 (9%) were non-white. There was a small male predominance (57%). Young people <17 years comprised 59%.

MAIN OUTCOME MEASURES

Autoantibody status and characteristics at presentation.

RESULTS

The majority presented with classical osmotic symptoms, weight loss and fatigue. Ketoacidosis was common (42%), especially in adults, and irrespective of ethnicity. 35% were overweight or obese. Of the 1778 participants who donated a blood sample, 85% were positive for one or more autoantibodies against glutamate decarboxylase, islet antigen-2 and zinc transporter 8. Presenting symptoms were similar in the autoantibody-positive and autoantibody-negative participants, as was the frequency of ketoacidosis (43%vs40%, P=0.3). Autoantibody positivity was less common with increasing age (P=0.0001), in males compared with females (82%vs90%, P<0.0001) and in people of non-white compared with white ethnicity (73%vs86%, P<0.0001). Body mass index was higher in autoantibody-negative adults than autoantibody-positive adults (median, IQR 25.5, 23.1-29.2vs23.9, 21.4-26.7 kg/m2; P=0.0001). Autoantibody-negative participants were more likely to have a parent with diabetes (28%vs16%, P<0.0001) and less likely to have another autoimmune disease (4%vs8%, P=0.01).

CONCLUSIONS

Most people assigned a diagnosis of type 1 diabetes presented with classical clinical features and islet autoantibodies. Although indistinguishable at an individual level, autoantibody-negative participants as a group demonstrated features more typically associated with other diabetes subtypes.

TRIAL REGISTRATION NUMBER

ISRCTN66496918; Pre-results.

Authors+Show Affiliations

No affiliation info availableDepartment of Medicine, Imperial College London, London, UK.Department of Medicine, Imperial College London, London, UK.Department of Medicine, Imperial College London, London, UK.Department of Medicine, Imperial College London, London, UK.School of Clinical Sciences, University of Bristol, Bristol, UK.School of Clinical Sciences, University of Bristol, Bristol, UK.Department of Paediatrics, University of Cambridge, Cambridge, UK.School of Medicine, Cardiff University, Cardiff, UK.Department of Immunobiology, King's College London, London, UK.Department of Medicine, Imperial College London, London, UK.Department of Medicine, Imperial College London, London, UK.No affiliation info available

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29622578

Citation

Bravis, Vassiliki, et al. "Relationship Between Islet Autoantibody Status and the Clinical Characteristics of Children and Adults With Incident Type 1 Diabetes in a UK Cohort." BMJ Open, vol. 8, no. 4, 2018, pp. e020904.
Bravis V, Kaur A, Walkey HC, et al. Relationship between islet autoantibody status and the clinical characteristics of children and adults with incident type 1 diabetes in a UK cohort. BMJ Open. 2018;8(4):e020904.
Bravis, V., Kaur, A., Walkey, H. C., Godsland, I. F., Misra, S., Bingley, P. J., ... Johnston, D. G. (2018). Relationship between islet autoantibody status and the clinical characteristics of children and adults with incident type 1 diabetes in a UK cohort. BMJ Open, 8(4), pp. e020904. doi:10.1136/bmjopen-2017-020904.
Bravis V, et al. Relationship Between Islet Autoantibody Status and the Clinical Characteristics of Children and Adults With Incident Type 1 Diabetes in a UK Cohort. BMJ Open. 2018 04 4;8(4):e020904. PubMed PMID: 29622578.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship between islet autoantibody status and the clinical characteristics of children and adults with incident type 1 diabetes in a UK cohort. AU - Bravis,Vassiliki, AU - Kaur,Akaal, AU - Walkey,Helen C, AU - Godsland,Ian F, AU - Misra,Shivani, AU - Bingley,Polly J, AU - Williams,Alistair J K, AU - Dunger,David B, AU - Dayan,Colin M, AU - Peakman,Mark, AU - Oliver,Nick S, AU - Johnston,Desmond G, AU - ,, Y1 - 2018/04/04/ PY - 2018/4/7/entrez PY - 2018/4/7/pubmed PY - 2019/2/28/medline KW - epidemiology KW - general diabetes KW - immunology KW - paediatric endocrinology SP - e020904 EP - e020904 JF - BMJ open JO - BMJ Open VL - 8 IS - 4 N2 - OBJECTIVES: To describe the characteristics of children and adults with incident type 1 diabetes in contemporary, multiethnic UK, focusing on differences between the islet autoantibody negative and positive. DESIGN: Observational cohort study. SETTING: 146 mainly secondary care centres across England and Wales. PARTICIPANTS: 3312 people aged ≥5 years were recruited within 6 months of a clinical diagnosis of type 1 diabetes via the National Institute for Health Research Clinical Research Network. 3021 were of white European ethnicity and 291 (9%) were non-white. There was a small male predominance (57%). Young people <17 years comprised 59%. MAIN OUTCOME MEASURES: Autoantibody status and characteristics at presentation. RESULTS: The majority presented with classical osmotic symptoms, weight loss and fatigue. Ketoacidosis was common (42%), especially in adults, and irrespective of ethnicity. 35% were overweight or obese. Of the 1778 participants who donated a blood sample, 85% were positive for one or more autoantibodies against glutamate decarboxylase, islet antigen-2 and zinc transporter 8. Presenting symptoms were similar in the autoantibody-positive and autoantibody-negative participants, as was the frequency of ketoacidosis (43%vs40%, P=0.3). Autoantibody positivity was less common with increasing age (P=0.0001), in males compared with females (82%vs90%, P<0.0001) and in people of non-white compared with white ethnicity (73%vs86%, P<0.0001). Body mass index was higher in autoantibody-negative adults than autoantibody-positive adults (median, IQR 25.5, 23.1-29.2vs23.9, 21.4-26.7 kg/m2; P=0.0001). Autoantibody-negative participants were more likely to have a parent with diabetes (28%vs16%, P<0.0001) and less likely to have another autoimmune disease (4%vs8%, P=0.01). CONCLUSIONS: Most people assigned a diagnosis of type 1 diabetes presented with classical clinical features and islet autoantibodies. Although indistinguishable at an individual level, autoantibody-negative participants as a group demonstrated features more typically associated with other diabetes subtypes. TRIAL REGISTRATION NUMBER: ISRCTN66496918; Pre-results. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/29622578/Relationship_between_islet_autoantibody_status_and_the_clinical_characteristics_of_children_and_adults_with_incident_type_1_diabetes_in_a_UK_cohort L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&amp;pmid=29622578 DB - PRIME DP - Unbound Medicine ER -