ESPE Abstracts

Background: Emerging evidence suggests the presence of distinct endotypes of type 1 diabetes mellitus (T1DM): T1DE1 in individuals diagnosed at age <7 years in contrast to T1DE2 in those diagnosed at ≥13 years of age. We aimed to comprehensively explore the phenotypic heterogeneity of T1DM with respect to the age-related endotypes.

Methods: This cross-sectional study was conducted in China involving 1,204 children newly diagnosed with Type 1 diabetes (T1D) admitted to the pediatric department of a tertiary hospital from January 1, 2010, to December 31, 2023. The patients were divided into three age groups: <7 years (T1DE1), 7~12 years, and ≥13 years (T1DE2). A comparison was made among the age groups regarding demographic characteristics, glucose metabolism, β-cell autoimmunity, and metabolic decompensation.

Results: Patients under 7 years exhibited a shorter symptom duration before diagnosis, along with the lowest fasting and postprandial C-peptide and CGR levels, and the highest postprandial glucose levels. They also showed the highest IAA positivity rate and CK-MB levels. In contrast, patients aged 13 and older had the highest HbA1c levels and GADA positivity rate. Additionally, this group showed the highest prevalence of TPOAb and TgAb positivity, as well as the largest proportion of abnormal liver function cases.

Conclusions: The study illustrates age-specific phenotypic heterogeneity in pediatric T1DM, indicating the presence of distinct endotypes. Further investigation of these endotypes may offer more evidence for the precise treatment of T1DM.