OBJECTIVE This study was conducted to evaluate the effects of early clinical diagnosis of type 1 diabetes by comparison of clinical parameters at diagnosis and during follow-up in patients with pediatric type 1 diabetes with early, intermediate, and late diagnosis. RESEARCH DESIGN AND METHODS In a population-based analysis, data on 14,292 pediatric patients with type 1 diabetes diagnosed between 2015 and 2019 were retrieved from the Diabetes Prospective Documentation (DPV) registry in March 2023. Patients were divided into four groups: one with diabetic ketoacidosis (DKA) at diagnosis and three with early, intermediate, or late diagnosis based on age-dependent HbA1c terciles. Laboratory-measured HbA1c values and those estimated from continuous glucose monitoring were aggregated as a combined glucose indicator (CGI). Insulin-dose adjusted CGI values <9% were defined as partial remission. RESULTS At diagnosis, patients had a median age of 9.8 years (IQR = 6.8; 13.0). Three years later, patients with early diagnosis had lower CGI than patients with late diagnosis or DKA (mean [95% CI] 7.46% [7.40; 7.53] vs. 7.81% [7.75; 7.87] or 7.74% [7.68; 7.79], respectively; each P < 0.001). More patients experienced partial remission (12.6% [11.0; 14.4] vs. 9.1% [7.7; 10.7] or 8.6% [7.3; 10.0]; each P < 0.001), and 11.7% [10.2; 13.5] of patients with intermediate diagnosis were in partial remission. CONCLUSIONS Early clinical diagnosis of type 1 diabetes may be beneficial for metabolic control and remission after 3 years of follow-up. Patients diagnosed early may represent a distinct group with better resources or with a different disease biology and slower β-cell destruction, which needs further evaluation.

中文翻译：

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早期诊断与晚期诊断的 1 型糖尿病儿科患者的临床结果：DPV 登记分析


目的 本研究通过比较早期、中期和晚期诊断的儿童 1 型糖尿病患者诊断时和随访期间的临床参数，评估 1 型糖尿病早期临床诊断的效果。研究设计和方法 在一项基于人群的分析中，从 2023 年 3 月的糖尿病前瞻性文献 (DPV) 登记处检索了 2015 年至 2019 年间诊断的 14,292 名 1 型糖尿病儿科患者的数据。患者被分为四组：一组患有糖尿病诊断时为酮症酸中毒 (DKA)，根据年龄依赖性 HbA1c 三位数进行早期、中期或晚期诊断。实验室测量的 HbA1c 值和通过连续血糖监测估计的值汇总为组合血糖指标 (CGI)。胰岛素剂量调整后的 CGI 值 <9% 定义为部分缓解。结果 诊断时，患者的中位年龄为 9.8 岁（IQR = 6.8；13.0）。三年后，早期诊断患者的 CGI 低于晚期诊断或 DKA 患者（平均 [95% CI] 7.46% [7.40; 7.53] vs. 7.81% [7.75; 7.87] 或 7.74% [7.68; 7.79]，分别；每个P< 0.001)。更多患者获得部分缓解（12.6% [11.0; 14.4] 对比 9.1% [7.7; 10.7] 或 8.6% [7.3; 10.0]；每个 P < 0.001）和 11.7% [10.2; 10.7] 13.5] 中间诊断的患者处于部分缓解状态。结论 1 型糖尿病的早期临床诊断可能有利于代谢控制和 3 年随访后的缓解。早期诊断的患者可能代表一个独特的群体，拥有更好的资源或具有不同的疾病生物学和较慢的β细胞破坏，这需要进一步评估。