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Volume
19, Issue
4, December
2003 |
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Table
of Contents 19-4 |
Clinical, Autoimmune, and HLA
Characteristics of Children Diagnosed With Type 1 Diabetes Before 5 Years
of Age
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 Hathout
EH et al. Pediatrics 2003;111:860-863. |
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Abstract |
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Little is known about auxologic, autoimmune,
and HLA characteristics specific to children with early-onset diabetes (EOD).
In this paper 40 children with a mean CA of 2.6 years who developed
diabetes mellitus before 5 years of age were studied. These patients were
compared with a matched subgroup of children of mean age of 9.9 years,
therefore, with later onset diabetes mellitus (LOD). Auxologic data and
antibody radioimmunoassay data from medical records were retrospectively
analyzed. HLA diabetes related class II alleles were typed and evaluated
for comparison between "whites" and "Hispanics" . The frequencies of
glutamic acid decarboxylase (GAD) and islet cell antibodies (ICA) were
significantly lower in the EOD group than in the group developing diabetes
at an older age. No significant differences were detectable for insulin
auto-antibodies (IAA), thyroid peroxidase, and thyroglobulin antibodies.
None of the patients of the EOD group developed hypothyroidism, whereas
20% of the LOD patients did. There was a negative correlation between GAD
antibodies and the predisposing haplotype DR3/DQ2. None of the EOD
patients had either of the protective alleles (DRB1*1501 or DQB1*0602) for
diabetes. There were significant differences in the frequencies of some
diabetes related HLA alleles between EOD patients and a large non-age
stratified type 1 diabetes group. The pertinent clinical information,
frequency of autosomal markers and HLA data among ethnic groups are below
(Tables 1,
2,
3). The authors concluded that
children with EOD have different diabetes related autoimmune and genetic
characteristics from those diagnosed later on in life. Hathout EH et al.
Pediatrics 2003;111:860-863.
Editor’s Comment: Very young children with diabetes mellitus are
known to have a more severe course than those diagnosed later in life. The
difficulties in the control of the disease among the younger patients may
account for more frequent and more severe complications of the disease
occurring earlier in life. However, the data in this paper are suggestive
that there are autoimmune and genetic differences among type 1 diabetic
patients according to age (early vs late onset), and these may account for
the differences in the control and the outcome of the disease. Chromosomal
abnormalities (parental isodisomy of chromosome 6) also have been
described among patients with the transient form of neonatal diabetes.1
Studies like these suggest that EOD probably is not classic type 1
diabetes mellitus, and thus may require unique approaches for prevention
and therapy.
Fima Lifshitz, MD
Reference
1.
Metz C et al. J Pediatr 2002;141:483-489.
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