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 - ADDRESS-2 Management Committee
AU - Patient Advocate Group and Investigators
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 - Narendran, Parth
PY - 2018/4/4
Y1 - 2018/4/4
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.
AB - 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.
U2 - 10.1136/bmjopen-2017-020904
DO - 10.1136/bmjopen-2017-020904
M3 - Article
SN - 2044-6055
VL - 8
JO - BMJ open
JF - BMJ open
IS - 4
M1 - e020904
ER -