Characteristics of children diagnosed with type 1 diabetes before vs after 6 years of age in the TEDDY cohort study – published online 22/07/2021

Jeffrey P. Krischer, Xiang Liu, Åke Lernmark, William A. Hagopian, Marian J. Rewers, Jin-Xiong She, Jorma Toppari, Anette-G. Ziegler, Beena Akolkar, on behalf of the TEDDY Study Group

In this issue, Krischer et al (https://doi.org/10.1007/s00125-021-05514-3) compared the prognostic factors and characteristics of children diagnosed with type 1 diabetes before 6 years of age with those diagnosed at 6–13 years of age, using participants enrolled in The Environmental Determinants of Diabetes in the Young (TEDDY) study. They found that children who developed type 1 diabetes at 0–6 years of age developed a persistent confirmed autoantibody at a younger age than those who were diagnosed with diabetes at 6–12 years of age. Specifically, diabetes diagnosed before 6 years of age was likely to be preceded by insulin autoantibodies, which developed earlier than GAD autoantibodies in this group. In contrast, autoantibodies first appearing against insulinoma antigen-2 were found only in those who developed diabetes at 6–13 years of age. Children who developed diabetes at a younger age also progressed to diabetes more rapidly than children who developed diabetes at 6–13 years of age (mean duration of time between the first-appearing autoantibody and diabetes diagnosis: 1.9 years vs 5.4 years). Among those who developed diabetes at 6–13 years of age, once multiple autoantibodies had been observed, there was not a statistically significant association between progression to type 1 diabetes and the age of the child or family history of type 1 diabetes. Diabetes risk associated with HLA genotypes was statistically significant in those who developed diabetes in both age groups. The authors conclude that these findings suggest that factors associated with diabetes risk need to be conditioned on age to be properly understood.

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