Family history and ethnicity influencing clinical presentation of type 1 diabetes in childhood.

Abstract

A different clinical presentation of type 1 diabetes (T1DM) could be supposed in children belonging to different ethnicities, with or without family history of autoimmunity. This study investigates the effect of ethnicity and family history of T1DM on clinical characteristics at presentation in a group of T1DM children. One hundred ninety-six T1DM children <18years, consecutively diagnosed during the years 2011-2014, were studied including 91% of Caucasians of Italian ancestry and 9% of non-Caucasian origin. Children with 1st or 2nd degree relatives affected by T1DM were younger at disease onset (p=0.005) and showed lower HbA1C levels (p=0.002), and higher IAA levels (p=0.01). Non-Caucasian children were younger at disease onset (p=0.029), and showed more severe hyperglycemia (p=0.008) and ketoacidosis (pH p<0.001). HbA1C levels were negatively related to positive family history of T1DM (p=0.01), fasting C-peptide levels (p=0.003), IAA levels (p=0.03), and IA-2 levels (p=0.003). The level of pH was positively influenced by fasting C-peptide (p=0.004), and negatively impacted by C-reactive protein (p=0.01) and non-Caucasian ethnicity (p=0.03). The milder metabolic decompensation in children with a positive family history of T1DM is probably explained by the awareness of the families in terms of early symptoms of T1DM, while the younger age at onset and the higher levels of autoantibodies may suggest a stronger genetic susceptibility, associated with a more aggressive autoimmune process. The younger age in non-Caucasian children is probably explained by the higher genetic susceptibility in subjects belonging to ethnic groups with a low T1DM incidence. Social aspects and poor living conditions probably predominate in determining the increased severity of metabolic decompensation at onset in children from non-Caucasian ethnicities.