The Journal of Clinical Endocrinology and Metabolism Journal Article

Factors Associated With C-Peptide Decline

March 22, 2021
 

Andrea K Steck, Xiang Liu, Jeffrey P Krischer, Michael J Haller, Riitta Veijola, Markus Lundgren, Simi Ahmed, Beena Akolkar, Jorma Toppari, William A Hagopian, Marian J Rewers, Helena Elding Larsson
The Journal of Clinical Endocrinology & Metabolism, Volume 106, Issue 3, March 2021, Pages e1380–e1388
https://doi.org/10.1210/clinem/dgaa715

Abstract

Context

Understanding factors involved in the rate of C-peptide decline is needed to tailor therapies for type 1 diabetes (T1D).

Objective

Evaluate factors associated with rate of C-peptide decline after a T1D diagnosis in young children.

Design

Observational study.

Setting

Academic centers.

Participants

A total of 57 participants from the Environmental Determinants of Diabetes in the Young (TEDDY) study who were enrolled at 3 months of age and followed until T1D, and 56 age-matched children diagnosed with T1D in the community.

Intervention

A mixed meal tolerance test was used to measure the area under the curve (AUC) C-peptide at 1, 3, 6, 12, and 24 months postdiagnosis.

Outcome

Factors associated with rate of C-peptide decline during the first 2 years postdiagnosis were evaluated using mixed effects models, adjusting for age at diagnosis and baseline C-peptide.

Results

Adjusted slopes of AUC C-peptide decline did not differ between TEDDY subjects and community controls (P = 0.21), although the former had higher C-peptide baseline levels. In univariate analyses combining both groups (n = 113), younger age, higher weight and body mass index z-scores, female sex, an increased number increased number of islet autoantibodies, and IA-2A or ZnT8A positivity at baseline were associated with a higher rate of C-peptide loss. Younger age, female sex, and higher weight z-score remained significant in multivariate analysis (all P < 0.02). At 3 months after diagnosis, higher HbA1c became an additional independent factor associated with a higher rate of C-peptide decline (P < 0.01).

Conclusion

Younger age at diagnosis, female sex, higher weight z-score, and HbA1c were associated with a higher rate of C-peptide decline after T1D diagnosis in young children.

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