ESPE Abstracts

Introduction: Type 1 diabetes (T1D) is due to decreased insulin production due to autoimmune destruction of β cells. There is an increase in the diagnosis of T1D in young patients with poor pancreatic reserve due to greater destruction of β cells and more complex evolution.

Objectives: To classify patients into different Endotypes based on age, characteristics at onset, and progression one year later.

Material and Methods: Prospective descriptive study carried out in a tertiary hospital. Inclusion criteria: Patients <18 years of age recently diagnosed with T1D. Patients are classified according to age at diagnosis (Group1 <7 years, Group2 >7 years). Blood samples were obtained at onset and sociodemographic (age, sex, direct relatives with T1D), clinical (duration of previous symptoms, other autoimmune diseases), analytical (grade of ketoacidosis, HbA1c, C-peptide), and immunological (GAD65A/IA2A autoantibodies and %memory regulatory CD4+ lymphocytes (Treg)) variables were collected. At 12 months, metabolic control was evaluated by HbA1c and time in range (TIR) and the pancreatic reserve with C-peptide.

Results: 67 patients (58% men) were recruited. Average age 9.5 years. 31.3% belonged to Group1, a group predominantly of men (71%) (P = 0.083), with a lower percentage of relatives with T1D (4.7% vs 10.8%, p0.69) and other autoimmune diseases (4.7% vs 13%, p0.54). Group1 was diagnosed with less duration of symptoms (2.2 vs 5.7 weeks, P <0.05) and lower HbA1c (10.1%[9,3-10,6] vs 12.1%[10,7-13,6], P <0.01) but with more severe ketoacidosis compared to Group2 (EB -11[-23,5-(-2,4)] vs -4.7[-11,9-(-1,6)], P <0.05, HCO3 14.7[6,2-21,8] vs 20.5[13,3-24,3], P <0.05). Significantly lower %Treg was observed at onset in Group1 compared to Group2, suggesting altered immunoregulation. Group1 presented significantly lower C-peptide levels at onset (0.2[0,1-0,3] vs 0.4[0,2-0,6], P >0.05) and at 12 months (0.1[0,01-0,1] vs 0.5[0,2-0,7], P <0.01) compared to Group2. One year later, the TIR and HbA1c had a tendency to be worse in Group1 compared to Group2 (TIR 51,0% [38-66] vs 59.5%[40-71.75], P = 0.357 and HbA1c 7.6%[7-8.2] vs 7.2%[6.3-7.0], P = 0.084).

Conclusion: In our center, the percentage of T1D diagnosed at younger age was 31.3%, with males predominating (71%) and with a lower history of autoimmunity. -This group represents a more aggressive subtype of T1D (with lower %Treg, lower pancreatic reserve, and rapidly exhaustible), the classic Endotype 1, suggesting the need for preventive/intensive treatments. Also, family history is less frequent, so performing population screening at an early age would be interesting.