Introduction
Methods
Results
Variable | n | Familial, n=519 (10.4%) | Sporadic, n=4474 (89.6%) | p value | Adjusted p valuea |
---|---|---|---|---|---|
Demographics | |||||
Age at diagnosis, years, mean ± SD | 4993 | 7.84 ± 3.88 | 8.05 ± 3.89 | 0.229 | |
Sex, male, % (95% CI) | 4993 | 55.7 (51.4, 60.0) | 56.7 (55.2, 58.1) | 0.705 | |
Pubertal, % (95% CI) | 3764 | 16.9 (13.2, 20.6) | 17.2 (15.9, 18.4) | 0.941 | 0.445 |
Metabolic decompensation at diagnosis | |||||
Duration of symptoms, % | 4614 | <0.001 | <0.001 | ||
No symptoms | 2.1 | 0.8 | |||
< 1 week | 38.1 | 20.8 | |||
1–4 weeks | 46.6 | 58.7 | |||
> 4 weeks | 13.1 | 19.7 | |||
Impaired consciousness, % (95% CI) | 4784 | 1.6 (0.5, 2.7) | 5.9 (5.2, 6.6) | <0.001 | <0.001 |
Ketoacidosis, % (95% CI) | 4817 | 7.8 (5.4, 10.1) | 19.1 (18.0, 20.3) | <0.001 | <0.001 |
Severe ketoacidosis, % (95% CI) | 4817 | 2.4 (1.1, 3.7) | 4.9 (4.2, 5.5) | 0.017 | 0.018 |
Weight loss, %, median (range) | 4610 | 2.0 (0–25.3) | 5.6 (0–40.0) | <0.001 | <0.001 |
pH, median (range) | 4817 | 7.40 (6.93–7.57) | 7.38 (6.72–7.54) | <0.001 | <0.001 |
β-Hydroxybutyrate, mmol/l, median (range) | 4384 | 0.50 (0–18.0) | 1.90 (0–27.0) | <0.001 | <0.001 |
Plasma glucose, mmol/l, median (range) | 4869 | 20.8 (3.6–63.7) | 24.2 (3.2–97.6) | <0.001 | <0.001 |
HbA1c, mmol/mol, median (range) | 841 | 76.0 (38.0–141.5) | 92.0 (36.0–189.0) | <0.001 | <0.001 |
HbA1c, %, median (range) | 841 | 9.1 (5.6–15.1) | 10.6 (5.4–19.4) | <0.001 | <0.001 |
Autoantibodies | |||||
ICA, % (95% CI) | 4738 | 90.9 (88.3, 93.5) | 91.8 (91.0, 92.7) | 0.535 | 0.400 |
ICA, JDFU, median (range) | 4347 | 64.0 (3.0–2620.0) | 64.0 (3.0–5120.0) | 0.894 | 0.585 |
IAA, % (95% CI) | 4738 | 49.8 (45.3, 54.2) | 42.2 (40.7, 43.7) | 0.002 | 0.004 |
IAA, RU, median (range) | 2037 | 10.5 (2.9–484.9) | 10.2 (2.8–7809.0) | 0.771 | 0.329 |
IA-2A, % (95% CI) | 4738 | 75.4 (71.6, 79.2) | 75.0 (73.7, 76.3) | 0.890 | 0.806 |
IA-2A, RU, median (range) | 3556 | 104.2 (0.8–223.2) | 105.8 (0.8–553.3) | 0.768 | 0.811 |
GADA, % (95% CI) | 4738 | 67.1 (63.0, 71.3) | 66.3 (64.8, 67.7) | 0.735 | 0.679 |
GADA, RU, median (range) | 3144 | 43.3 (5.4–3800.0) | 35.7 (5.4–24,849.0) | 0.245 | 0.080 |
ZnT8A, % (95% CI) | 4738 | 66.3 (62.1, 70.5) | 69.8 (68.4, 71.1) | 0.132 | 0.155 |
ZnT8A, RU, median (range) | 3289 | 12.0 (0.5–186.7) | 12.1 (0.5–1201.9) | 0.753 | 0.767 |
Number of positive antibodies, median (mean) | 4738 | 4 (3.50) | 4 (3.45) | 0.252 | 0.183 |
Number of positive biochemical antibodies, median (mean) | 4738 | 3 (2.59) | 3 (2.53) | 0.182 | 0.211 |
Autoantibody negative, % (95% CI) | 4738 | 3.5 (1.9, 5.2) | 2.1 (1.7, 2.6) | 0.079 | 0.041 |
Positivity for multiple (≥2) autoantibodies, % (95% CI) | 4738 | 92.8 (90.5, 95.1) | 92.5 (91.7, 93.2) | 0.875 | 0.911 |
Genetics | 4993 | ||||
DR3-DQ2/DR4-DQ8, % (95% CI) | 23.7 (20.0, 27.4) | 21.1 (19.9, 22.2) | 0.182 | 0.186 | |
DR3-DQ2/xb, % (95% CI) | 13.1 (10.2, 16.0) | 15.6 (14.5, 16.6) | 0.156 | 0.143 | |
DR4-DQ8/yc, % (95% CI) | 52.0 (47.7, 56.3) | 47.5 (46.0, 48.9) | 0.055 | 0.049 | |
xb/yc, % (95% CI) | 11.2 (8.5, 13.9) | 15.9 (14.8, 17.0) | 0.006 | 0.006 | |
DR3-DQ2, % (95% CI) | 36.8 (32.7, 41.0) | 36.6 (35.2, 38.0) | 0.979 | 0.975 | |
DR4-DQ8, % (95% CI) | 75.7 (72.0, 79.4) | 68.5 (67.1, 69.9) | 0.001 | 0.001 | |
Risk group, % | 0.157 | 0.162 | |||
0 | 0.4 | 0.8 | |||
1 | 1.7 | 2.1 | |||
2 | 13.5 | 16.2 | |||
3 | 20.4 | 23.0 | |||
4 | 40.3 | 36.8 | |||
5 | 23.7 | 21.1 |
Variable | n | 1. Affected father, n=253 (5.1%) | 2. Affected mother, n=141 (2.8%) | 3. Affected sibling, n=95 (1.9%) | 4. ≥2 affected family members, n=30 (0.6%) | 5. Sporadic, n=4474 (89.6%) | p value | Adjusted p valuea |
---|---|---|---|---|---|---|---|---|
Demographics | ||||||||
Sex, male, % (95% CI) | 4993 | 57.3 (51.2, 63.4) | 48.2 (40.0, 56.5) | 55.8 (45.8, 65.8) | 76.7 (61.5, 91.8) | 56.7 (55.2, 58.1) | 0.061 | |
Pubertal, % (95% CI) | 3764 | 15.4 (10.3, 20.4) | 9.6 (4.2, 15.1) | 30.4 (19.6, 41.3) | 26.3 (6.5, 46.1) | 17.2 (15.9, 18.4) | 0.005 | 0.551 |
Metabolic decompensation at diagnosis | ||||||||
Duration of symptoms, % | 4614 | <0.001 | <0.001 | |||||
No symptoms | 1.3 | 1.5 | 4.7 | 3.7 | 0.8 | |||
<1 week | 31.0 | 44.6 | 41.9 | 55.6 | 20.8 | |||
1–4 weeks | 52.4 | 42.3 | 39.5 | 40.7 | 58.7 | |||
>4 weeks | 15.3 | 11.5 | 14.0 | 0 | 19.7 | |||
1 vs 3: 0.015 | ||||||||
1 vs 4: 0.007 | ||||||||
1 vs 5: 0.006 | ||||||||
2 vs 4: 0.049 | ||||||||
2 vs 5: <0.001 | ||||||||
3 vs 5: <0.001 | ||||||||
4 vs 5: <0.001 | ||||||||
Impaired consciousness, % (95% CI) | 4784 | 1.6 (0, 3.2) | 0.7 (0, 2.2) | 2.2 (0, 5.2) | 3.6 (0, 10.4) | 5.9 (5.2, 6.6) | 0.003 | 0.010 |
1 vs 5: 0.010 | ||||||||
2 vs 5: 0.036 | ||||||||
Weight loss, %, median (range) | 4610 | 3.2 (0–21.3) | 0 (0–19.7) | 1.6 (0–25.3) | 3.4 (0–14.8) | 5.6 (0–40.0) | <0.001 | <0.001 |
1 vs 2: 0.006 | ||||||||
1 vs 5: <0.001 | ||||||||
2 vs 4: 0.034 | ||||||||
2 vs 5: <0.001 | ||||||||
3 vs 4: 0.045 | ||||||||
3 vs 5: <0.001 | ||||||||
pH, median (range) | 4817 | 7.40 (6.97–7.57) | 7.40 (7.00–7.53) | 7.40 (6.93–7.46) | 7.40 (7.09–7.44) | 7.38 (6.72–7.54) | <0.001 | <0.001 |
1 vs 5: <0.001 | ||||||||
2 vs 5: <0.001 | ||||||||
3 vs 5: <0.001 | ||||||||
4 vs 5: 0.007 | ||||||||
β-Hydroxybutyrate, mmol/l, median (range) | 4384 | 0.69 (0–12.1) | 0.30 (0–9.5) | 0.50 (0–18.0) | 0.70 (0–17.4) | 1.90 (0–27.0) | <0.001 | <0.001 |
1 vs 5: <0.001 | ||||||||
2 vs 5: <0.001 | ||||||||
3 vs 5: <0.001 | ||||||||
4 vs 5: <0.001 | ||||||||
Plasma glucose, mmol/l, median (range) | 4869 | 21.5 (3.9–62.8) | 19.7 (3.6–47.8) | 20.0 (4.6–56.5) | 20.8 (9.6–63.7) | 24.2 (3.2–97.6) | <0.001 | <0.001 |
1 vs 5: <0.001 | ||||||||
2 vs 5: <0.001 | ||||||||
3 vs 5: <0.001 | ||||||||
HbA1c, mmol/mol, median (range) | 841 | 75.5 (38.0–141.5) | 78.0 (40.0–132.8) | 82.0 (39.9–121.0) | 67.0 (64.0–96.0) | 92.0 (36.0–189.0) | <0.001 | <0.001 |
1 vs 5: <0.001 | ||||||||
2 vs 4: 0.025 | ||||||||
2 vs 5: 0.016 | ||||||||
HbA1c, %, median (range) | 841 | 9.1 (5.6–15.1) | 9.3 (5.8–14.3) | 9.7 (5.8–13.2) | 8.3 (8.0–10.9) | 10.6 (5.4–19.4) | <0.001 | 0.002 |
1 vs 5: <0.01 | ||||||||
2 vs 4: 0.022 | ||||||||
2 vs 5: 0.013 |
Autoantibodies | n | 1. Affected father, n=253 (5.1%) | 2. Affected mother, n=141 (2.8%) | 3. Affected sibling, n=95 (1.9%) | 4. ≥2 affected family members, n=30 (0.6%) | 5. Sporadic, n=4474 (89.6%) | p value | Adjusted p valuea |
---|---|---|---|---|---|---|---|---|
ICA, % (95% CI) | 4738 | 89.5 (85.5, 93.4) | 93.3 (89.1, 97.5) | 92.8 (87.2, 98.3) | 86.2 (73.3, 98.8) | 91.8 (91.0, 92.3) | 0.487 | 0.451 |
ICA, JDFU, median (range) | 4347 | 64.0 (3.0–2620.0) | 49.0 (3.0–2048.0) | 64.0 (4.0–1024.0) | 47.0 (5.0–1024.0) | 64.0 (3.0–5120.0) | 0.530 | 0.866 |
IAA, % (95% CI) | 4738 | 49.8 (43.4, 56.2) | 47.4 (39.0, 55.8) | 51.8 (41.1, 62.6) | 55.2 (37.1, 73.3) | 42.2 (40.7, 43.7) | 0.027 | 0.003 |
2 vs 3: 0.018 | ||||||||
3 vs 5: <0.01 | ||||||||
IAA, RU, median (range) | 2037 | 9.9 (2.9–260.0) | 13.5 (3.2–338.7) | 9.0 (2.9–48.8) | 10.7 (3.5–484.9) | 10.2 (2.8–7809.0) | 0.437 | 0.447 |
IA-2A, % (95% CI) | 4738 | 74.3 (68.7, 79.8) | 80.0 (73.3, 86.7) | 74.7 (65.3, 84.1) | 65.5 (48.2, 82.8) | 75.0 (73.7, 76.3) | 0.515 | 0.433 |
IA-2A, RU, median (range) | 3556 | 102.1 (0.9–223.2) | 99.7 (1.1–202.5) | 110.3 (0.8–185.0) | 121.2 (18.3–186.6) | 105.8 (0.8–553.3) | 0.067 | 0.032 |
4 vs 5: 0.058 | ||||||||
GADA, % (95% CI) | 4738 | 67.1 (61.1, 73.1) | 67.4 (59.5, 75.3) | 69.9 (60.0, 79.7) | 58.6 (40.7, 76.5) | 66.3 (64.8, 67.7) | 0.848 | 0.942 |
GADA, RU, median (range) | 3144 | 49.8 (5.4–3800.0) | 43.3 (6.3–277.4) | 37.2 (6.4–349.4) | 35.6 (7.4–185.3) | 35.7 (5.4–24,849.0) | 0.826 | 0.192 |
ZnT8A, % (95% CI) | 4738 | 65.0 (58.9, 71.1) | 63.7 (55.6, 71.8) | 75.9 (66.7, 85.1) | 62.1 (44.4, 79.7) | 69.8 (68.4, 71.1) | 0.141 | 0.243 |
ZnT8A, RU, median (range) | 3289 | 11.1 (0.5–186.7) | 10.9 (0.6–138.4) | 16.1 (0.6–126.8) | 21.9 (0.6–93.0) | 12.1 (0.5–1201.9) | 0.428 | 0.985 |
Number of positive antibodies, median (mean) | 4738 | 4 (3.46) | 4 (3.52) | 4 (3.65) | 4 (3.28) | 4 (3.45) | 0.835 | 0.436 |
Number of positive biochemical antibodies, median (mean) | 4738 | 3 (2.56) | 3 (2.59) | 3 (2.72) | 3 (2.41) | 3 (2.53) | 0.831 | 0.483 |
Autoantibody negative, % (95% CI) | 4738 | 3.0 (0.8, 5.1) | 3.0 (0.1, 5.8) | 3.6 (0, 7.6) | 10.3 (0, 21.4) | 2.1 (1.7, 2.6) | 0.049 | 0.091 |
Positivity for multiple (≥2) autoantibodies, % (95% CI) | 4738 | 92.0 (88.5, 95.4) | 94.1 (90.1, 98.1) | 95.2 (90.6, 99.8) | 86.2 (73.7, 98.8) | 92.5 (91.7, 93.2) | 0.542 | 0.552 |
Genetics, % (95% CI) | 1. Affected father, n=253 (5.1%) | 2. Affected mother, n=141 (2.8%) | 3. Affected sibling, n=95 (1.9%) | 4. ≥2 affected family members, n=30 (0.6%) | 5. Sporadic, n=4474 (89.6%) | p value | Adjusted p valuea |
---|---|---|---|---|---|---|---|
DR3-DQ2/DR4-DQ8 | 21.3 (16.3, 26.4) | 23.4 (16.4, 30.4) | 29.5 (20.3, 38.6) | 26.7 (10.8, 42.5) | 21.1 (19.9, 22.2) | 0.306 | 0.238 |
DR3-DQ2/xb | 11.1 (7.2, 14.9) | 17.0 (10.8, 23.2) | 12.6 (6.0, 19.3) | 13.3 (1.2, 25.5) | 15.6 (14.5, 16.6) | 0.320 | 0.313 |
DR4-DQ8/yc | 56.1 (50.0, 62.2) | 51.1 (42.8, 59.3) | 42.1 (32.2, 52.0) | 53.3 (35.5, 71.2) | 47.5 (46.0, 48.9) | 0.052 | 0.048 |
1 vs 3: <0.05 | |||||||
1 vs 5: <0.05 | |||||||
xb/yc | 11.5 (7.5, 15.4) | 8.5 (3.9, 13.1) | 15.8 (8.5, 23.1) | 6.7 (0, 15.6) | 15.9 (14.8, 17.0) | 0.030 | 0.044 |
2 vs 5: <0.05 | |||||||
DR3-DQ2 homozygosity | 3.2 (1.0, 5.3) | 2.8 (0.1, 5.6) | 3.2 (0, 6.7) | 3.3 (0, 9.8) | 3.0 (2.5, 3.5) | 0.971 | 1.000 |
DR4-DQ8 homozygosity | 15.0 (10.6, 19.4) | 10.6 (5.5, 15.7) | 8.4 (2.8, 14.0) | 10.0 (0, 20.7) | 7.6 (6.9, 8.4) | 0.001 | 0.001 |
1 vs 5: 0.001 | |||||||
DR3-DQ2 | 32.4 (26.6, 38.2) | 40.4 (32.3, 48.5) | 42.1 (32.2, 52.0) | 40.0 (22.5, 57.5) | 36.6 (35.2, 38.0) | 0.381 | 0.336 |
DR4-DQ8 | 77.5 (72.3, 82.6) | 74.5 (67.3, 81.7) | 71.6 (62.5, 80.6) | 80.0 (65.7, 94.3) | 68.5 (67.1, 70.0) | 0.012 | 0.015 |
1 vs 5: <0.05 |
Variable | n | Before, n=349 (87.0%) | After, n=52 (13.0%) | p value | Adjusted p valuea |
---|---|---|---|---|---|
Demographics | |||||
Age at diagnosis, years, median (range) | 401 | 6.98 (0.59–14.96) | 9.57 (1.60–14.94) | 0.001 | |
Sex, male, % (95% CI) | 401 | 54.4 (49.2, 59.7) | 65.4 (52.5, 78.3) | 0.183 | |
Affected parent, father, % (95% CI) | 401 | 66.2 (61.2, 71.2) | 50.0 (36.4, 63.6) | 0.034 | 0.006 |
Pubertal, % (95% CI) | 313 | 12.1 (8.3, 15.9) | 31.3 (15.2, 47.3) | 0.007 | 0.964 |
Metabolic decompensation at diagnosis | |||||
Duration of symptoms, % | 368 | 0.962 | 0.807 | ||
No symptoms | 1.3 | 0 | |||
<1 week | 37.3 | 36.7 | |||
1–4 weeks | 47.6 | 51.0 | |||
>4 weeks | 13.8 | 12.2 | |||
Impaired consciousness, % (95% CI) | 386 | 1.8 (0.4, 3.2) | 0 | 1.000 | 0.998 |
Ketoacidosis, % (95% CI) | 393 | 7.9 (5.1, 10.8) | 5.8 (0, 12.1) | 0.782 | 0.645 |
Weight loss, kg, median (range) | 368 | 0.30 (0–15.0) | 1.10 (0–7.0) | 0.065 | 0.442 |
Weight loss, %, median (range) | 367 | 1.6 (0–21.3) | 3.8 (0–19.7) | 0.195 | 0.316 |
pH, median (range) | 393 | 7.40 (6.97–7.54) | 7.40 (7.20–7.45) | 0.303 | 0.269 |
β-Hydroxybutyrate, mmol/l, median (range) | 346 | 0.50 (0–12.1) | 0.49 (0–17.4) | 0.960 | 0.850 |
Plasma glucose, mmol/l, median (range) | 396 | 21.7 (3.6–62.8) | 20.3 (4.8–63.7) | 0.417 | 0.452 |
HbA1c, mmol/mol, median (range) | 63 | 72.0 (38.0–141.5) | 107.0 (71.0–132.8) | 0.007 | 0.007 |
HbA1c, %, median (range) | 63 | 8.7 (5.6–15.1) | 12.0 (8.7–14.3) | 0.006 | 0.007 |
Autoantibodies | |||||
ICA, % (95% CI) | 379 | 90.3 (87.1, 93.5) | 92.0 (84.5, 99.5) | 1.000 | 0.380 |
ICA, JDFU, median (range) | 343 | 49.0 (3.0–2620.0) | 64.0 (4.0–2048.0) | 0.463 | 0.963 |
IAA, % (95% CI) | 379 | 52.0 (46.6, 57.4) | 32.0 (19.1, 44.9) | 0.013 | 0.163 |
IAA, RU, median (range) | 187 | 10.6 (2.9–484.9) | 14.0 (3.0–338.7) | 0.197 | 0.463 |
IA-2A, % (95% CI) | 379 | 74.5 (69.8, 79.2) | 88.0 (79.0, 97.0) | 0.055 | 0.022 |
IA-2A, RU, median (range) | 289 | 104.4 (0.9–202.5) | 87.1 (1.4–157.5) | 0.201 | 0.375 |
GADA, % (95% CI) | 379 | 67.5 (62.4, 72.5) | 62.0 (48.5, 75.5) | 0.545 | 0.381 |
GADA, RU, median (range) | 253 | 45.4 (5.4–3800.0) | 47.9 (6.3–277.4) | 0.782 | 0.385 |
ZnT8A, % (95% CI) | 379 | 62.6 (57.4, 67.8) | 76.0 (64.2, 87.8) | 0.092 | 0.115 |
ZnT8A, RU, median (range) | 244 | 10.4 (0.5–186.7) | 17.0 (0.6–138.4) | 0.396 | 0.297 |
Number of positive antibodies, median (mean) | 379 | 4 (3.47) | 4 (3.50) | 0.701 | 0.292 |
Number of positive biochemical antibodies, median (mean) | 379 | 3 (2.57) | 3 (2.58) | 0.810 | 0.932 |
Autoantibody negative, % (95% CI) | 379 | 3.0 (1.2, 4.9) | 6.0 (0, 12.6) | 0.393 | 0.709 |
Positivity for multiple (≥2) autoantibodies, % (95% CI) | 379 | 92.7 (89.9, 95.5) | 94.0 (87.4, 1) | 1.000 | 0.373 |
Genetics | 401 | ||||
DR3-DQ2/DR4-DQ8, % (95% CI) | 22.9 (18.5, 27.3) | 19.2 (8.5, 29.9) | 0.677 | 0.483 | |
DR3-DQ2/xb, % (95% CI) | 14.0 (10.4, 17.7) | 9.6 (1.6, 17.6) | 0.513 | 0.465 | |
DR4-DQ8/yc, % (95% CI) | 53.6 (48.3, 58.8) | 51.9 (38.3, 65.5) | 0.940 | 0.923 | |
xb/yc, % (95% CI) | 9.5 (6.4, 12.5) | 19.2 (8.5, 29.9) | 0.059 | 0.069 | |
DR3-DQ2, % (95% CI) | 37.0 (31.9, 42.0) | 28.8 (16.5, 41.2) | 0.325 | 0.261 | |
DR4-DQ8, % (95% CI) | 76.5 (72.1, 81.0) | 71.2 (58.8, 83.5) | 0.505 | 0.424 | |
Risk group, % | 0.125 | 0.404 | |||
0 | 0.6 | 0 | |||
1 | 1.1 | 3.8 | |||
2 | 11.5 | 23.1 | |||
3 | 22.3 | 15.4 | |||
4 | 41.5 | 38.5 | |||
5 | 22.9 | 19.2 |