■个性化治疗已成为一种考虑疾病异质性的可能更有效的方法。这项研究的目的是确定最近描述的儿童糖尿病亚组是否与糖尿病特异性并发症有预后关联,因此,可能是个性化治疗的基础。
■我们将先前开发的亚组分类应用于来自前瞻性糖尿病患者随访(DPV)注册表的儿科患者(糖尿病发病<18岁),并记录了2000年1月1日至2022年3月31日之间的数据,来自德国的糖尿病中心,奥地利,瑞士,卢森堡。分类需要胰岛自身抗体状态的信息,年龄,血红蛋白A1c(HbA1c),和身体质量指数(BMI-SDS)在疾病表现,以及2年和4年后的随访数据,在22,719名患者中可用。没有关于这些参数的记录数据的患者从分析中排除。严重低血糖的累积风险,糖尿病酮症酸中毒(DKA),视网膜病变,在中位随访6.8年(IQR4.8-9.6)期间,通过Kaplan-Meier分析对肾病进行了分析.
■患者分为10个亚组(P1-P7胰岛自身抗体阳性,n=19,811;N1-N3胰岛自身抗体阴性,n=2908)。在特定的急性和慢性并发症方面,各组差异显着。严重低血糖是年轻胰岛自身抗体阳性亚组P1,P3,P4(10年风险46,46和47%)和胰岛自身抗体阴性组N1,N2(43和46%)的特征。在患者组P2和P5中发现肾病(10年风险为16%),具有中度疾病的特征,如保留的C肽,低HbA1c,糖尿病发病时DKA的频率非常低。P7组,由高BMI定义,与不良的代谢控制有关,DKA,和视网膜病变。相比之下,高BMI(N3)的胰岛自身抗体阴性患者的4种并发症风险均较低.
■糖尿病发病的儿童糖尿病分组为急性和慢性糖尿病特异性并发症的发展提供了预后价值。
■DPV计划由德国糖尿病研究中心内的德国教育和研究部(BMBF)支持,罗伯特·科赫研究所的糖尿病监测,德国糖尿病协会(DDG)和INNODIA。
UNASSIGNED: Personalised therapy has emerged as a possibly more efficient approach taking disease heterogeneity into account. The aim of this
study was to determine whether recently described subgroups of childhood diabetes have prognostic association with diabetes-specific complications and, therefore, might be a basis for personalised therapies.
UNASSIGNED: We applied a previously developed subgroup classification to pediatric patients (diabetes onset <18 years) from the prospective Diabetes Patient Follow-up (DPV) registry with documented data between January 1, 2000 and March 31, 2022, from diabetes centers in Germany, Austria, Switzerland, and Luxembourg. The classification required information on islet autoantibody status, age, haemoglobin A1c (HbA1c), and body-mass index (BMI-SDS) at disease manifestation, as well as follow up data after 2 and after 4 years, which was available in 22,719 patients. Patients without documented data on these parameters were excluded from the analysis. The cumulative risk of severe hypoglycemia, diabetic ketoacidosis (DKA), retinopathy, and nephropathy were analysed by Kaplan-Meier analyses over a median follow-up of 6.8 years (IQR 4.8-9.6).
UNASSIGNED: Patients were classified into 10 subgroups (P1-P7 islet autoantibody-positive, n = 19,811; N1-N3 islet autoantibody-negative, n = 2908). The groups varied markedly with respect to specific acute and chronic complications. Severe hypoglycemia was a characteristic feature in young islet autoantibody-positive subgroups P1, P3, P4 (10-year risk 46, 46 and 47%) and the islet autoantibody-negative groups N1, N2 (43 and 46%). Nephropathy was identified in patient groups P2 and P5 (10-year risk 16%), which had features of moderate disease such as preserved C-peptide, low HbA1c, and very low frequency of DKA at diabetes onset. Group P7, which was defined by a high BMI, was associated with poor metabolic control, DKA, and retinopathy. In contrast, islet autoantibody-negative patients with high BMI (N3) had a low risk for all four complications.
UNASSIGNED: Subgrouping of childhood diabetes at diabetes onset provided prognostic value for the development of acute and chronic diabetes-specific complications.
UNASSIGNED: The DPV initiative is supported by The German Ministry of Education and Research (BMBF) within the German Center for Diabetes Research, the diabetes surveillance of the Robert Koch Institute, the German Diabetes Association (DDG) and INNODIA.