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Diabetologia
Published in: Diabetologia 12/2012

01-12-2012 | Article

Clinical evolution of beta cell function in youth with diabetes: the SEARCH for Diabetes in Youth study

Authors: D. Dabelea, E. J. Mayer-Davis, J. S. Andrews, L. M. Dolan, C. Pihoker, R. F. Hamman, C. Greenbaum, S. Marcovina, W. Fujimoto, B. Linder, G. Imperatore, R. D’Agostino Jr

Published in: Diabetologia | Issue 12/2012

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Abstract

Aims/hypothesis

Few studies have explored the epidemiology of beta cell loss in youth with diabetes. This report describes the evolution and major determinants of beta cell function, assessed by fasting C-peptide (FCP), in the SEARCH for Diabetes in Youth study.

Methods

Participants were 1,277 youth with diabetes (948 positive for diabetes autoantibodies [DAs] and 329 negative for DAs), diagnosed when aged <20 years, who were followed from a median of 8 months post diagnosis, for approximately 30 months. We modelled the relationship between rate of change in log FCP and determinants of interest using repeated measures general linear models.

Results

Among DA-positive youth, there was a progressive decline in beta cell function of 4% per month, independent of demographics (age, sex, race/ethnicity), genetic susceptibility to autoimmunity (HLA risk), HbA1c and BMI z score, or presence of insulin resistance. Among DA-negative youth, there was marked heterogeneity in beta cell loss, reflecting an aetiologically mixed group. This group likely includes youths with undetected autoimmunity (whose decline is similar to that of DA-positive youth) and youth with non-autoimmune, insulin-resistant diabetes, with limited decline (~0.7% per month).

Conclusions/interpretation

SEARCH provides unique estimates of beta cell function decline in a large sample of youth with diabetes, indicating that autoimmunity is the major contributor. These data contribute to a better understanding of clinical evolution of beta cell function in youth with diabetes, provide strong support for the aetiological classification of diabetes type and may inform tertiary prevention efforts targeted at high-risk groups.
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Metadata
Title
Clinical evolution of beta cell function in youth with diabetes: the SEARCH for Diabetes in Youth study
Authors
D. Dabelea
E. J. Mayer-Davis
J. S. Andrews
L. M. Dolan
C. Pihoker
R. F. Hamman
C. Greenbaum
S. Marcovina
W. Fujimoto
B. Linder
G. Imperatore
R. D’Agostino Jr
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
Diabetologia / Issue 12/2012
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-012-2719-6

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