• Media type: E-Article
  • Title: Age of Diagnosis Does Not Alter the Presentation or Progression of Robustly Defined Adult-Onset Type 1 Diabetes
  • Contributor: Thomas, Nicholas J.; Hill, Anita V.; Dayan, Colin M.; Oram, Richard A.; McDonald, Timothy J.; Shields, Beverley M.; Jones, Angus G.; Simon, Godwin; Ramos, Angelo; Norris, Andrea; Tan, Kai; Narendran, Parth; Ramtoola, Shenaz; Ali, Amar; Banerjee, Moulinath; Brooks, Augustin; Chakera, Ali; Johnson, Andrew; Tatovic, Danijela; Ballav, Chitrabhanu; Dayan, Colin; Nair, Sunil; Game, Francis; Beames, Susan; [...]
  • imprint: American Diabetes Association, 2023
  • Published in: Diabetes Care
  • Language: English
  • DOI: 10.2337/dc22-2159
  • ISSN: 0149-5992; 1935-5548
  • Keywords: Advanced and Specialized Nursing ; Endocrinology, Diabetes and Metabolism ; Internal Medicine
  • Origination:
  • Footnote:
  • Description: <jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>To determine whether presentation, progression, and genetic susceptibility of robustly defined adult-onset type 1 diabetes (T1D) are altered by diagnosis age.</jats:p> </jats:sec> <jats:sec> <jats:title>RESEARCH DESIGN AND METHODS</jats:title> <jats:p>We compared the relationship between diagnosis age and presentation, C-peptide loss (annual change in urine C-peptide–creatinine ratio [UCPCR]), and genetic susceptibility (T1D genetic risk score [GRS]) in adults with confirmed T1D in the prospective StartRight study, 1,798 adults with new-onset diabetes. T1D was defined in two ways: two or more positive islet autoantibodies (of GAD antibody, IA-2 antigen, and ZnT8 autoantibody) irrespective of clinical diagnosis (n = 385) or one positive islet autoantibody and a clinical diagnosis of T1D (n = 180).</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>In continuous analysis, age of diagnosis was not associated with C-peptide loss for either definition of T1D (P &amp;gt; 0.1), with mean (95% CI) annual C-peptide loss in those diagnosed before and after 35 years of age (median age of T1D defined by two or more positive autoantibodies): 39% (31–46) vs. 44% (38–50) with two or more positive islet autoantibodies and 43% (33–51) vs. 39% (31–46) with clinician diagnosis confirmed by one positive islet autoantibody (P &amp;gt; 0.1). Baseline C-peptide and T1D GRS were unaffected by age of diagnosis or T1D definition (P &amp;gt; 0.1). In T1D defined by two or more autoantibodies, presentation severity was similar in those diagnosed before and after 35 years of age: unintentional weight loss, 80% (95% CI 74–85) vs. 82% (76–87); ketoacidosis, 24% (18–30) vs. 19% (14–25); and presentation glucose, 21 mmol/L (19–22) vs. 21 mmol/L (20–22) (all P ≥ 0.1). Despite similar presentation, older adults were less likely to be diagnosed with T1D, insulin-treated, or admitted to hospital.</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>When adult-onset T1D is robustly defined, the presentation characteristics, progression, and T1D genetic susceptibility are not altered by age of diagnosis.</jats:p> </jats:sec>
  • Access State: Open Access