HbA1c Predicts Time to Diagnosis of Type 1 Diabetes in Children at Risk.

Abstract

Prediction of type 1 diabetes is based on the detection of multiple islet autoantibodies in subjects who are at increased genetic risk. Prediction of the timing of diagnosis is challenging, however. We assessed the utility of HbA1c levels in predicting the clinical disease in genetically predisposed children with multiple autoantibodies. Cord blood samples from 168,055 newborn infants were screened for class II HLA genotypes in Finland, and 14,876 children with increased genetic risk for type 1 diabetes were invited to participate in regular follow-ups, including screening for diabetes-associated autoantibodies. When two or more autoantibodies were detected, HbA1c levels were analyzed at each visit. During follow-up, multiple (two or more) autoantibodies developed in 466 children; type 1 diabetes was diagnosed in 201 of these children (43%, progressors), while 265 children remained disease free (nonprogressors) by December 2011. A 10% increase in HbA1c levels in samples obtained 3-12 months apart predicted the diagnosis of clinical disease (hazard ratio [HR] 5.7 [95% CI 4.1-7.9]) after a median time of 1.1 years (interquartile range [IQR] 0.6-3.1 years) from the observed rise of HbA1c. If the HbA1c level was ≥5.9% (41 mmol/mol) in two consecutive samples, the median time to diagnosis was 0.9 years (IQR 0.3-1.5, HR 11.9 [95% CI 8.8-16.0]). In conclusion, HbA1c is a useful biochemical marker when predicting the time to diagnosis of type 1 diabetes in children with multiple autoantibodies.

• Authors: Olli Helminen, Susanna Aspholm, Tytti Pokka, Milla-Riikka Hautakangas, Nora Haatanen, Johanna Lempainen, Jorma Ilonen, Olli Simell, Mikael Knip, Riitta Veijola
• Journal: Diabetes (Diabetes) Vol. 64 Issue 5 Pg. 1719-27 (May 2015) ISSN: 1939-327X [Electronic] United States
• PMID: 25524912 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Chemical References

• Autoantibodies
• Glycated Hemoglobin A
• HLA Antigens
• hemoglobin A1c protein, human

Topics

• Autoantibodies (blood)
• Child
• Child, Preschool
• Diabetes Mellitus, Type 1 (blood, diagnosis)
• Female
• Fetal Blood
• Finland (epidemiology)
• Gene Expression Regulation
• Genetic Predisposition to Disease
• Genotype
• Glycated Hemoglobin (genetics, metabolism)
• HLA Antigens (genetics)
• Humans
• Infant
• Infant, Newborn
• Male