3 Key Takeaways
Plain English Summary- 01Core Finding
FE-1 and IRT concentrations were measured prospectively in 301 at-risk children followed in the Environmental Determinants of Islet Autoimmunity (ENDIA) cohort from birth.
- 02Study Evidence
Tested in a observational cohort study (216 children) at the real-world cohort stage.
- 03Practical Meaning
Observational cohort findings reveal real-world links, though lifestyle or unmeasured factors cannot be fully ruled out without an RCT.
What This Means for You
Changes in exocrine biomarkers were detectable early in the natural history of type 1 diabetes, with a delayed rise of FE-1 in infants who later progressed to multiple islet autoantibodies or type 1 diabetes and a decrease in IRT following islet autoantibody seroconversion.
The Discovery
The exocrine pancreas is increasingly implicated in type 1 diabetes. Noninvasive biomarkers of exocrine function, fecal elastase-1 (FE-1) and serum immunoreactive trypsin (IRT), may provide early insight into disease pathogenesis. We investigated the temporal relationship between exocrine biomarkers and type 1 diabetes development in children. FE-1 and IRT concentrations were measured prospectively in 301 at-risk children followed in the Environmental Determinants of Islet Autoimmunity (ENDIA) cohort from birth. A total of 216 children provided 1,679 stool samples; 242 provided 1,014 serum samples. biomarker (measurable biological signal) trajectories were compared between children who developed islet autoimmunity or type 1 diabetes and age- and sex-matched control children negative for autoantibodies in a nested case-control design. Adjusted linear mixed models were used. Two biomarker patterns were observed. FE-1 concentrations were lower during the first 6 months of life in children who subsequently developed multiple islet autoantibodies or type 1 diabetes (β-coefficient at birth -0.61 [95% CI -1.04, -0.17]; P = 0.006; β-coefficient at 3 months -0.39 [95% CI -0.69, -0.09]; P = 0.010); IRT concentrations were lower in children who developed type 1 diabetes 12 months (β = -0.30 [95% CI -0.58, -0.02]; P = 0.034) and 18 months (β = -0.40 [95% CI -0.71, -0.10]; P = 0.008) before type 1 diabetes diagnosis.
How It Works, Simply
This endocrinology research focuses on immune response · Blood biomarker (measurable biological signal). Researchers evaluated it using an observational cohort study (216 children) at the real-world cohort stage of medical research.
3 Key Takeaways
Clinical Takeaways- 01Core Finding
FE-1 and IRT concentrations were measured prospectively in 301 at-risk children followed in the Environmental Determinants of Islet Autoimmunity (ENDIA) cohort from birth.
- 02Study Evidence
Tested in a observational cohort study (216 children) at the real-world cohort stage.
- 03Practical Meaning
Observational cohort findings reveal real-world links, though lifestyle or unmeasured factors cannot be fully ruled out without an RCT.
Biological Mechanism & Study Design
Study Design & Cohort
Observational cohort study
Observational cohort study (216 children) · Real-World Cohort
Biological Pathway & Modality
Immune response · Blood biomarker
Intervention: Longitudinal Changes in Exocrine Biomarkers in Children at Risk of Type 1 Diabetes
Experimental Findings & Endpoints
The exocrine pancreas is increasingly implicated in type 1 diabetes.
Noninvasive biomarkers of exocrine function, fecal elastase-1 (FE-1) and serum immunoreactive trypsin (IRT), may provide early insight into disease pathogenesis. We investigated the temporal relationship between exocrine biomarkers and type 1 diabetes development in children.
FE-1 and IRT concentrations were measured prospectively in 301 at-risk children followed in the Environmental Determinants of Islet Autoimmunity (ENDIA) cohort from birth. A total of 216 children provided 1,679 stool samples; 242 provided 1,014 serum samples.
Biomarker trajectories were compared between children who developed islet autoimmunity or type 1 diabetes and age- and sex-matched control children negative for autoantibodies in a nested case-control design. Adjusted linear mixed models were used.
Two biomarker patterns were observed. FE-1 concentrations were lower during the first 6 months of life in children who subsequently developed multiple islet autoantibodies or type 1 diabetes (β-coefficient at birth -0.61 [95% CI -1.04, -0.17]; P = 0.006; β-coefficient at 3 months -0.39 [95% CI -0.69, -0.09]; P = 0.010); IRT concentrations were lower in children who developed type 1 diabetes 12 months (β = -0.30 [95% CI -0.58, -0.02]; P = 0.034) and 18 months (β = -0.40 [95% CI -0.71, -0.10]; P = 0.008) before type 1 diabetes diagnosis.
Clinical Translation & Practice Context
Changes in exocrine biomarkers were detectable early in the natural history of type 1 diabetes, with a delayed rise of FE-1 in infants who later progressed to multiple islet autoantibodies or type 1 diabetes and a decrease in IRT following islet autoantibody seroconversion.
The Bottom Line · Clinical Pearl
“Changes in exocrine biomarkers were detectable early in the natural history of type 1 diabetes, with a delayed rise of FE-1 in infants who later progressed to multiple islet autoantibodies or type 1 diabetes and a decrease in IRT following islet autoantibody seroconversion.”
Published in Diabetes Care · Current Stage: Real-World Cohort