Stages of type 1 diabetes in children and adolescents
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2/27/2018 at 8:53:30 AM GMT
Posts: 34
Stages of type 1 diabetes in children and adolescents

Dear ISPAD member/friend,

Thank you for your continued interest in the 2018 ISPAD Clinical Practice Consensus Guidelines and in the previous drafts chapters we shared with you.

We are happy to announce that the Chapter Stages of type 1 diabetes in children and adolescents is now ready for you to read and comment on. We are looking forward to hearing your thoughts and input on this chapter.

Kind regards,

David Maahs

ISPAD Secretary-General



Last edited Monday, May 14, 2018
3/2/2018 at 9:31:35 PM GMT
Posts: 9

Overall, a very nice summary.

Stages 1 and 2 are defined as having 2 or more autoantibodies.

I have a semantic comment. It may not be absolutely clear that multiple means more than one. It is often used to mean several (i.e., more than 2).  Therefore, I suggest explicitly stating at least 2 or 2 or more autoantibodies.

 

Page 4 The terminology used for HLA genotyping is confusing to non-experts. As written, it is not clear whether DQ2/DQ8 is an alternative nomenclature for DR3/DR4. I suggest re-writing this section with the non-expert reader in mind.

 

This sentence is confusing: “There are likely other, as yet unknown, islet antigens, as the presence of islet cell antibodies confer added risk for development of T1D in individuals with other antibodies.”  What are the other antibodies referred to?

 

Pages 6 and 7 It is notable that studies with GAD-alum are not mentioned.

 

Page 10 “Recent data suggest that most individuals with type 1 diabetes have minimal residual c-peptide secretion by age 7 years (Hattersley). The citation is missing.

 

Table 1 Candidiasis may also occur in boys wearing diapers. How about replacing (vulvo)vaginal candidiasis with the gender-neutral term perineal candidiasis?



3/4/2018 at 5:55:30 AM GMT
Posts: 4
Stages of diabetes
Quote:
Originally posted by J. Wolfsdorf:

Overall, a very nice summary.

Stages 1 and 2 are defined as having 2 or more autoantibodies.

I have a semantic comment. It may not be absolutely clear that multiple means more than one. It is often used to mean several (i.e., more than 2).  Therefore, I suggest explicitly stating at least 2 or 2 or more autoantibodies.

 

Page 4 The terminology used for HLA genotyping is confusing to non-experts. As written, it is not clear whether DQ2/DQ8 is an alternative nomenclature for DR3/DR4. I suggest re-writing this section with the non-expert reader in mind.

 

This sentence is confusing: “There are likely other, as yet unknown, islet antigens, as the presence of islet cell antibodies confer added risk for development of T1D in individuals with other antibodies.”  What are the other antibodies referred to?

 

Pages 6 and 7 It is notable that studies with GAD-alum are not mentioned.

 

Page 10 “Recent data suggest that most individuals with type 1 diabetes have minimal residual c-peptide secretion by age 7 years (Hattersley). The citation is missing.

 

Table 1 Candidiasis may also occur in boys wearing diapers. How about replacing (vulvo)vaginal candidiasis with the gender-neutral term perineal candidiasis?

Thank you to the authors and I agree with Joe's comments.

 

I suggest that the Title of the Chapter could include "and Prevention studies".

 

Could the authors please review the references for the statement that "Individuals with a first degree relative with type 1 diabetes have an approximately 15 fold increased relative risk of type 1 diabetes" References date from 1984, 1993 and the most recent reference is 2012 of an Italian twin study.

 

Could the authors clarify the statement that "IVGTT is not required as a prognostic tool". For the clinician it has little value but may be helpful in a research setting.

 

Could the authors also clarify on page 8 "Children and adolescents were participants in these trials and in general had a better C peptide response to adults" : is this to the intervention or at baseline? i.e. were they better responders to the intervention or in general?





Last edited Sunday, March 4, 2018
4/8/2018 at 4:50:02 PM GMT
Posts: 2
Thank you all so much for putting these important guidelines together. I’d like to offer a thought re: [Differentiating between type 1 and type 2 diabetes at diagnosis (pgs. 2 & 10)
Features suggesting the diagnosis of type 2 diabetes rather than type 1 diabetes at diagnosis include:
•Overweight or obesity
•Age greater than 10 years
•Strong family history of type 2 diabetes
•Acanthosis nigricans
•High-risk racial or ethnic group
•Undetectable islet autoantibodies]

The inclusion of high-risk racial or ethnic group here stands out to me as potentially problematic. I understand the impetus, as rates of T2D are higher in African American and Latino populations than NHW, but at the same time, since rates of DKA at diagnosis for youth with T1D are higher in African American and Latino populations as well(1) and rates of obesity/overweight are high in AA youth with T1D and also rising across all ethnic/racial groups,(2,3) I would be concerned that the inclusion of this statement here might inadvertently cause bias, resulting in T1D being overlooked in racial/ethnic minority youth. This is unlikely to happen, but even if it happens once, it could be life-threatening for the individual. Perhaps a caveat something along the following lines:
High-risk racial or ethnic group*
*Youth of high-risk racial or ethnic groups are also at increased risk for DKA at diagnosis of T1D,(1) so it is particularly important that they be screened for antibodies when T1D is suspected.

Thank you so much for the hard work.
Katie

Bibliography
1. Dabelea D, Rewers A, Stafford JM, et al. Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study. Pediatrics 2014;133(4):e938-45. doi:10.1542/peds.2013-2795.
2. Liu LL, Lawrence JM, Davis C, et al. Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth study. Pediatr Diabetes 2010;11(1):4-11. doi:10.1111/j.1399-5448.2009.00519.x.
3. Mayer-Davis EJ, Beyer J, Bell RA, et al. Diabetes in African American youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care 2009;32 Suppl 2:S112-22. doi:10.2337/dc09-S203.



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