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How Ethnicity Can Influence the Risk of Type 1 Diabetes

Oct 13, 2018
 
Editor: Joy Pape, MSN, FNP-C, CDE, WOCN, CFCN, FAADE

Author: Melissa Bailey, Pharm.D. Candidate, USF College of Pharmacy

Ethnicity can influence the risk of type 1 diabetes; obesity found as additional impact in patients with multiple autoantibody positivity.

Type 1 diabetes is known as a chronic autoimmune disease characterized by beta cell destruction, which leads to insulin deficiency. An abundance of data has been generated on multiple risk factors that enable healthcare practitioners to predict type 1 risk and create studies in order to intervene early in the autoimmune process, before the onset of symptoms. The current studies examining ethnic differences is underscored by recent data that demonstrates the increase in type 1 diabetes incidence disproportionally affects racial and ethnic minorities. However, most of the studies were conducted in the population who are non-Hispanic whites and generalizability to other ethnicities has not been established. While there are a limited amount of these studies, the risk and rate of progression of islet autoimmunity and type 1 diabetes development have not been compared in different ethnic groups at all.

Data was used from the Type 1 Diabetes TrialNet Pathway to Prevention Study to examine how ethnicity influences the progression of islet autoimmunity and type 1 diabetes. In the study, 4,873 relatives of patients with type 1 diabetes who themselves did not have diabetes and were autoantibody-positive were followed prospectively (11% were Hispanic, 80.9%  were non-Hispanic white, 2.9% were non-Hispanic black and 5.2% were non-Hispanic other). Researchers analyzed two major outcomes: time from single autoantibody positivity confirmation to multiple autoantibody positivity and time from multiple autoantibody positivity to diagnosis of type 1 diabetes.

After adjustments, transformation from single to multiple autoantibody positivity was not as common in those who were Hispanic individuals than in those who were non-Hispanic white individuals (HR 0.66; 95% CI; p = 0.028). In individuals who screened positive for multiple antibodies (n = 2834), time to type 1 diabetes diagnosis did not differ by ethnicity overall (p = 0.91). When multiple autoantibody positivity was determined, having obesity had differential effects by ethnicity. In white children who were non-Hispanic, the risk for type 1 diabetes was increased by 36% (HR 3.8; 95% CI; p-0.024) and was almost quadrupled in children who were Hispanic (HR 3.8; 95% CI;  p = 0.0026).

In the overall cohort, for participants who were positive for multiple autoantibodies at screening, time to type 1 diabetes did not differ significantly in ethnicity. Despite these findings, participants who were Hispanic appeared to be less likely to progress to type 1 diabetes than the white participants who were non-Hispanic, when obesity wasn’t a factor.

“Our data provide insight into the impact of race/ethnicity in type 1 diabetes progression and may be valuable for the design of predictive models and prevention trials,” researchers write. “Future studies aimed at identifying factors (e.g. genetic, epigenetic, environmental, etc.) contributing to slower progression in individuals who are Hispanic  will advance our understanding of the natural history of type 1 diabetes and may have a significant impact on the prevention of type 1 diabetes.”

Practice Pearls:

  • Data was used from the Type 1 Diabetes TrialNet Pathway to Prevention Study to examine how ethnicity influences the progression of islet autoimmunity and type 1 diabetes.
  • When multiple autoantibody positivity was determined, having obesity had differential effects by ethnicity, as the risk for type 1 diabetes in white children who are non-Hispanic was increased by 36% and was almost quadrupled in children who are Hispanic.
  • In the overall cohort, for participants who were positive for multiple autoantibodies at screening, time to type 1 diabetes did not differ significantly in ethnicity, although participants who are Hispanic appeared to be less likely to progress to type 1 diabetes than the white participants who are non-Hispanic, when obesity wasn’t a factor.

Reference:

Tosur, M., Geyer, S.M., Rodriguez, H. et al. “Ethnic differences in progression of islet autoimmunity and type 1 diabetes in relatives at risk.” Diabetologia (2018) 61: 2043. https://doi-org.ezproxy.hsc.usf.edu/10.1007/s00125-018-4660-9