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. 2009 Oct;32(10):1839-44.
doi: 10.2337/dc08-2326. Epub 2009 Jul 8.

Preservation of beta-cell function in autoantibody-positive youth with diabetes

Carla J Greenbaum  1 , Andrea M Anderson, Lawrence M Dolan, Elizabeth J Mayer-Davis, Dana Dabelea, Giuseppina Imperatore, Santica Marcovina, Catherine Pihoker; SEARCH Study Group
Affiliations

Preservation of beta-cell function in autoantibody-positive youth with diabetes

Carla J Greenbaum et al. Diabetes Care. 2009 Oct.

Abstract

Objective: To determine the extent of beta-cell function in youth with diabetes and GAD65 and/or IA2 autoantibodies.

Research design and methods: Fasting C-peptide levels from 2,789 GAD65- and/or IA2 autoantibody-positive youth aged 1-23 years from the SEARCH for Diabetes in Youth study were used. Preserved beta-cell function was defined on the basis of cut points derived from the Diabetes Control and Complications Trial (DCCT) (fasting C-peptide > or =0.23 ng/ml) and from the U.S. adolescent population of the National Health and Nutrition Examination Survey (NHANES) 5th percentile for fasting C-peptide (> or =1.0 ng/ml). We compared the clinical characteristics between those with and without preserved beta-cell function.

Results: Within the first year of diagnosis, 82.9% of youth had a fasting C-peptide > or =0.23 ng/ml and 31.2% had values > or =1.0 ng/ml. Among those with > or =5 years of diabetes duration, 10.7% had preserved beta-cell function based on the DCCT cutoff and 1.0% were above the 5th percentile of the NHANES population.

Conclusions: Within the 1st year of diagnosis, four of five youth with autoantibody-positive diabetes have clinically significant amounts of residual beta-cell function and about one-third have fasting C-peptide levels above the 5th percentile of a healthy adolescent population. Even 5 years after diagnosis, 1 of 10 has fasting C-peptide above a clinically significant threshold. These findings have implications for clinical classification of youth with diabetes as well as clinical trials aimed to preserve beta-cell function after diabetes onset.

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Figures

Figure 1
Figure 1
Percentage of participants with preserved C-peptide by duration of diabetes in 3-month intervals according to the DCCT definition (fasting C-peptide <0.23 ng/ml) (♦), NHANES 5th percentile definition (fasting C-peptide <1.0 ng/ml) (■), and NHANES 50th percentile definition (fasting C-peptide <1.9 ng/ml) (▴). N, number of participants in each 3-month interval.
Figure 2
Figure 2
Odds ratios for having preserved C-peptide according to the DCCT definition for individuals <1 year (♢), 1–2 years (■), and >2 years (●) from diagnosis. Incremental units are 1 mg/dl glucose, age 1 year, BMI 1 kg/m2, and A1C 1%. F, female; M, male.
Figure 3
Figure 3
Fasting C-peptide by duration and age at diagnosis among those with preserved C-peptide by DCCT definition. Cells with less than five subjects are not reported.
Figure 4
Figure 4
Percentage of participants with preserved C-peptide by duration of diabetes according to DCCT definition (fasting C-peptide <0.23 ng/ml) stratified by BMI classification (black bar, obese; dark gray bar, overweight; light gray bar, normal weight; white bar, underweight).
See this image and copyright information in PMC

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