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Review
. 2018 Sep 26;18(11):115.
doi: 10.1007/s11892-018-1083-4.

The Effect of Age on the Progression and Severity of Type 1 Diabetes: Potential Effects on Disease Mechanisms

Pia Leete  1 , Roberto Mallone  2 , Sarah J Richardson  1 , Jay M Sosenko  3 , Maria J Redondo  4 , Carmella Evans-Molina  5
Affiliations
Review

The Effect of Age on the Progression and Severity of Type 1 Diabetes: Potential Effects on Disease Mechanisms

Pia Leete et al. Curr Diab Rep. .

Abstract

Purpose of review: To explore the impact of age on type 1 diabetes (T1D) pathogenesis.

Recent findings: Children progress more rapidly from autoantibody positivity to T1D and have lower C-peptide levels compared to adults. In histological analysis of post-mortem pancreata, younger age of diagnosis is associated with reduced numbers of insulin containing islets and a hyper-immune CD20hi infiltrate. Moreover compared to adults, children exhibit decreased immune regulatory function and increased engagement and trafficking of autoreactive CD8+ T cells, and age-related differences in β cell vulnerability may also contribute to the more aggressive immune phenotype observed in children. To account for some of these differences, HLA and non-HLA genetic loci that influence multiple disease characteristics, including age of onset, are being increasingly characterized. The exception of T1D as an autoimmune disease more prevalent in children than adults results from a combination of immune, metabolic, and genetic factors. Age-related differences in T1D pathology have important implications for better tailoring of immunotherapies.

Keywords: Age; Autoimmunity; C-peptide; Type 1 diabetes; β cell.

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Conflict of interest statement

Conflict of Interest Pia Leete, Roberto Mallone, Sarah J. Richardson, Jay M. Sosenko, Maria J. Redondo, and Carmella Evans-Molina declare that they have no conflict of interest.

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