Clinical outcomes in pediatric patients with type 1 diabetes with early versus late diagnosis: analysis from the DPV registry

Objective This study aims at evaluating the effects of early clinical diagnosis of type 1 diabetes by comparison of clinical parameters at diagnosis and during follow-up in pediatric type 1 diabetes patients with early, intermediate and late diagnosis. Research design and methods In a population-based analysis, data of 14,292 pediatric patients with type 1 diabetes diagnosed between 2015 and 2019 were retrieved from the DPV registry in March 2023. Patients were divided into four groups, one with diabetic ketoacidosis (DKA) at diagnosis, and three with early, intermediate or late diagnosis based on age-dependent HbA1c terciles. Laboratory-measured HbA1c values and those estimated from CGM were aggregated as combined glucose indicator (CGI). Insulin-dose adjusted CGI values <9% were defined as partial remission. Results At diagnosis, patients had a median age of 9.8 years [IQR: 6.8 - 13.0]. Three years later, patients with early diagnosis had lower CGI than patients with late diagnosis or DKA (7.46% [7.40; 7.53] (mean [95% confidence interval]) vs. 7.81% [7.75; 7.87] or 7.74% [7.68; 7.79], respectively; each p<0.001). More patients experienced partial remission (12.6% [11.0; 14.4] vs. 9.1% [7.7; 10.7] or 8.6% [7.3; 10.0]; each p<0.001). 11.7% [10.2; 13.5] of patients with intermediate diagnosis were in partial remission. Conclusions Early clinical diagnosis of type 1 diabetes may be beneficial for metabolic control and remission after three years of follow-up. Patients diagnosed early may represent a distinct group with better resources or with a different disease biology and slower beta cell destruction, which needs further evaluation.