Reduced morbidity at diagnosis and improved glycemic control in children previously enrolled in DiPiS follow-up

• Published in: Pediatric diabetes Vol. 15; no. 7; pp. 494 - 501
• Main Authors: Lundgren, Markus, Sahlin, Åsa, Svensson, Camilla, Carlsson, Annelie, Cedervall, Elisabeth, Jönsson, Björn, Jönsson, Ida, Larsson, Karin, Lernmark, Åke, Neiderud, Jan, Vigård, Tore, Elding Larsson, Helena
• Format: Journal Article
• Language: English
• Published: Former Munksgaard John Wiley & Sons A/S 01-11-2014
• Subjects: Clinical Medicine; Cohort Studies; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - diagnosis; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - genetics; diabetic ketoacidosis; Diabetic Ketoacidosis - epidemiology; Diabetic Ketoacidosis - prevention & control; Early Diagnosis; Endocrinology and Diabetes; Endokrinologi och diabetes; Female; Follow-Up Studies; Genetic Predisposition to Disease; Glycated Hemoglobin A - analysis; HbA1c; Humans; Hyperglycemia - prevention & control; Hypoglycemia - prevention & control; Hypoglycemic Agents - therapeutic use; Incidence; Infant, Newborn; Insulin - therapeutic use; Klinisk medicin; Longitudinal Studies; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Pediatrics; Pediatrik; Prospective Studies; Risk; Sweden - epidemiology; type 1 diabetes; follow-up studies; type 1 diabetes; diabetic ketoacidosis; HbA1c
• ISSN: 1399-543X; 1399-5448
• DOI: 10.1111/pedi.12151

Aims/hypothesis
Children participating in longitudinal type 1 diabetes prediction studies were reported to have less severe disease at diabetes diagnosis. Our aim was to investigate children who from birth participated in the Diabetes Prediction in Skåne (DiPiS) study for metabolic status at diagnosis and then continued to be followed for 2 yr of regular clinical care.
Methods
Children, followed in DiPiS before diagnosis, were compared to children in the same birth cohort, who did not participate in follow‐up. Metabolic status, symptoms at diagnosis as well as hemoglobin A1c (HbA1c) and doses of insulin at 3, 6, 12, and 24 months after diagnosis were compared.
Results
Children, followed in DiPiS and diagnosed at 2–12 yr of age, had 0.8% (9 mmol/mol) lower HbA1c at diagnosis than those who were not followed (p = 0.006). At diagnosis, fewer DiPiS children had symptoms (p = 0.014) and ketoacidosis at diagnosis were reduced (2% compared to 18%, p = 0.005). During regular clinical care, HbA1c levels for the DiPiS children remained lower both at 12 (0.4% (4 mmol/mol); p = 0.009) and 24 months (0.8% (9 mmol/mol) p  <  0.001) after diagnosis, despite no difference in total daily insulin between the two groups.
Conclusions
Participation in prospective follow‐up before diagnosis of type 1 diabetes leads to earlier diagnosis with fewer symptoms, decreased incidence of ketoacidosis as well as better metabolic control up to 2 yr after diagnosis. Our data indicate that metabolic control at the time of diabetes diagnosis is important for early metabolic control possibly affecting the risk of long‐term complications.