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Exp Clin Endocrinol Diabetes 2024; 132(08): 432-442
DOI: 10.1055/a-2316-0512
Article

Type 1 Diabetes Mellitus in the First Years of Life – Onset, Initial Treatment, and Early Disease Course

J. Ziegler   #
1   University Hospital Tübingen, Department of Pediatric and Adolescent Medicine, Tübingen, Germany
,
S. R. Tittel   #
2   University of Ulm, Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
3   German Center for Diabetes Research e.V., Munich-Neuherberg, Germany
,
T. Biester
4   Children's Hospital Auf der Bult, Hanover, Germany
,
T. Kapellen
5   University Hospital Leipzig, Department of Pediatric and Adolescent Medicine, Leipzig, Germany
,
A. Dost
6   University Hospital Jena, Department of Pediatric and Adolescent Medicine, Jena, Germany
,
N. Rochow
7   University Hospital of Paracelsus Medical Private University, Department for Newborns, Children and Adolescents, Nuremberg, Germany
,
D.Seick Barbarini
8   Landeskrankenhaus Feldkirch, Academic Teaching Hospital, Department of Pediatrics, Feldkirch, Austria
,
A. Böhle
9   Wilhelmstift Children's Hospital, Hamburg, Germany
,
A. Galler
10   Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Berlin, Germany
,
R. W. Holl
2   University of Ulm, Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
3   German Center for Diabetes Research e.V., Munich-Neuherberg, Germany
› Author Affiliations
Funding Information This study was supported by the Deutsche Zentrum für Diabetesforschung (DZD) [German Center for Diabetes Research], (grant number 82DZD14E03), the German Diabetes Association (DDG), and the Diabetes Surveillance of the Robert Koch Institute.
› Further Information
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Abstract

Objective This study investigated the onset and the choice of treatment in children with very early onset of type 1 diabetes mellitus (T1D).

Methods The study included 5,763 patients from the German Diabetes Patient Follow-up registry with onset of T1D in the first 4 years of life from January 2010 – June 2022. The analysis included diabetes-specific parameters, anthropometric data, and mode of treatment at onset, within the first and second year of T1D. Three groups were compared according to age at onset (G1: 223 patients 6–<12 months, G2: 1519 patients 12–<24 months, G3: 4001 patients 24–48 months).

Results In 12.3% of all cases in childhood and adolescence, the incidence of diabetes in the first 4 years of life was rare. At the onset, clinical status was worse and diabetic ketoacidosis (DKA) rates were higher in G1 and G2 (52.3% and 46.5%, respectively) compared to G3 (27.3% (p<0.001)). G1 and G2 were significantly more likely to be treated with insulin pump therapy (CSII) 2 years after onset (98.1% and 94.1%, respectively)) compared to G3 (85.8%, p<0.001). Median HbA1c after 2 years did not differ between groups (G1: 7.27% (56.0 mmol/mol), G2: 7.34% (56.7 mmol/mol) and G3: 7.27% (56.0 mmol/mol)) or when comparing CSII vs MDI. The rate of severe hypoglycemia (SH) and DKA during the first 2 years of treatment did not differ among the three groups, ranging from 1.83–2.63/100 patient-years (PY) for DKA and 9.37–24.2/100 PY for SH. Children with T1D under 4 years of age are more likely to be diagnosed with celiac disease but less likely to have thyroiditis than older children with T1DM.

Conclusions Young children with T1D had high rates of DKA at onset and were predominantly treated with insulin pump therapy during the first 2 years. The median HbA1c for all three groups was<7.5% (58 mmol/mol) without increased risk of SH or DKA. The use of continuous glucose monitoring (CGM) was not associated with lower HbA1c in children under 48 months.

Keywords

diabetes  - autoimmunity - thyroiditis - autoimmunity - antibodies - autoimmunity

# J. Ziegler and S.R. Tittel contributed equally to this work.




Publication History

Received: 31 January 2024
Received: 21 April 2024

Accepted: 22 April 2024

Article published online:
14 August 2024

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