The Effect of Ethnicity in the Rate of Beta-Cell Functional Loss in the First 3 Years After Type 1 Diabetes Diagnosis
The Effect of Ethnicity in the Rate of Beta-Cell Functional Loss in the First 3 Years After Type 1 Diabetes Diagnosis
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DOI：
10.1210/clinem/dgaa348
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发表时间：
2020-12-01
影响因子：
5.8
通讯作者：
Redondo, Maria J.
中科院分区：
文献类型：
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作者：
Tosur, Mustafa;Cleves, Mario A.;Redondo, Maria J.
目的：比较不同种族在1型糖尿病(T1D)临床诊断中的代谢和免疫学特征，并在临床诊断后3年内评估种族对β细胞功能丧失的影响。研究方法和设计：我们研究了TrialNet新发病干预试验的参与者(n=624，中位年龄14.4岁，男性58%，西班牙裔8.7%)，并前瞻性跟踪他们3年。在临床确诊后6个月内进行混合餐耐量试验，每半年重复一次。结果：在第1天的临床诊断中，与非西班牙裔白人(NHW)相比，拉美裔患者的糖尿病酮症酸中毒(DKA)发生率更高(44.7%比25.3%，OR=2.36，P=0.01)，空腹血糖更低(97vs109 mg/dL，P=0.02)，空腹C肽水平更高(1.23比0.94 ng/mL，P=0.02)。自身抗体阳性率高(n=201，94.1%vs%，OR=7.98，P=0.05)。排除阳性临床试验的受试者后，在调整了年龄、性别、BMI-z评分和DKA后，拉美裔和非西班牙裔在临床诊断后前3年的C肽曲线下面积(AUC)轨迹没有显著差异(n=413，P=0.14)。结论：尽管拉美裔和非西班牙裔在临床诊断T1D时的代谢和免疫学特征存在差异，但在调整了体重指数和其他混杂因素后，临床诊断后前3年的C肽轨迹没有显著差异。这些发现可能为T1D的观察性研究和干预试验的设计提供参考。
Objective: We set forth to compare ethnicities for metabolic and immunological characteristics at the clinical diagnosis of type 1 diabetes (T1D) and assess the effect of ethnicity on beta-cell functional loss within 3 years after clinical diagnosis.Research Methods and Design: We studied participants in TrialNet New Onset Intervention Trials (n = 624, median age = 14.4 years, 58% male, 8.7% Hispanic) and followed them prospectively for 3 years. Mixed meal tolerance tests (MMTT) were performed within 6 months following clinical diagnosis and repeated semiannually. Unless otherwise indicated, analyses were adjusted for age, sex, BMI Z-score, and diabetes duration.Results: At T1D clinical diagnosis, Hispanics, compared with non-Hispanic whites (NHW), had a higher frequency of diabetic ketoacidosis (DKA) (44.7% vs 25.3%, OR = 2.36, P = 0.01), lower fasting glucose (97 vs 109 mg/dL, P = 0.02) and higher fasting C-peptide (1.23 vs 0.94 ng/mL, P = 0.02) on the first MMTT, and higher frequency of ZnT8 autoantibody positivity (n = 201, 94.1% vs 64%, OR = 7.98, P = 0.05). After exclusion of participants in experimental arms of positive clinical trials, C-peptide area under the curve (AUC) trajectories during the first 3 years after clinical diagnosis were not significantly different between Hispanics and NHW after adjusting for age, sex, BMI-z score, and DKA (n = 413, P = 0.14).Conclusion: Despite differences in the metabolic and immunological characteristics at clinical diagnosis of T1D between Hispanics and NHW, C-peptide trajectories did not differ significantly in the first 3 years following clinical diagnosis after adjustment for body mass index and other confounders. These findings may inform the design of observational studies and intervention trials in T1D.