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Ann Pediatr Endocrinol Metab > Accepted Articles
DOI: https://doi.org/10.6065/apem.2142170.085    [Accepted] Published online October 12, 2021.
Demographic and diagnostic markers in new onset pediatric type 1 and type 2 diabetes: differences and overlaps
Teresa Nieto1, Beatriz Castillo2, Jacobo Nieto3, Maria J. Redondo4 
1St. Agnes Academy, Houston, TX, USA
2Baylor College of Medicine, School of Medicine, Houston, TX, USA
3Rice University, Houston, TX, USA
4Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA
Address for correspondence:  Maria J. Redondo
Email: redondo@bcm.edu
Received: August 18, 2021   Revised: September 13, 2021   Accepted: September 23, 2021
Type 1 diabetes (T1D) is the most common type of diabetes in children, but the frequency of type 2 diabetes (T2D) is increasing rapidly. Classification of diabetes is based on a constellation of features that are typical of each type. We aimed to compare demographic, clinical and laboratory characteristics at diabetes diagnosis in pediatric T1D and T2D.
We studied children who attended a large academic hospital in Houston, Texas (USA) with a new diagnosis of T2D (n=753) or T1D (n=758). We compared age, sex, race/ethnicity, presence of obesity, glucose, hemoglobin A1c, islet autoantibody positivity, C-peptide, and presence of diabetic ketoacidosis (DKA) at diabetes diagnosis.
At diagnosis of diabetes, children with T2D, compared with those with T1D, were older (13.6 vs 9.7 years old), more likely females (63.2% vs 47.8%), of racial/ethnic minority (91.1% versus 42.3%) and obese (90.9% vs 19.4%), and were less likely to have DKA (7.8% vs 35.0%) and diabetes autoantibodies (5.5% vs 95.4%). Children with T2D also had significantly less marked elevation of glucose and hemoglobin A1c, and lower C-peptide levels (all comparisons, p<0.0001). In multiple logistic regression analysis, older age, racial/ethnic minority, obesity, higher C-peptide and negative islet autoantibodies were independently associated with T2D (all, p<0.05) while sex, glucose, hemoglobin A1c and DKA were not (model p<0.0001).
There are important demographic, clinical and laboratory differences between T1D and T2D in children. However, none of the characteristics was unique to either diabetes type, which poses challenges to diabetes classification at diagnosis.
Keywords: Type 1 diabetes, Type 2 diabetes, Pediatric, Diagnosis, Overlap, Classification, Autoimmunity
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