Clinical Characteristics and Temporal Trends of Pediatric Diabetes Subtypes Over 20 Years in a Tertiary Center in Korea.
Differentiating diabetes subtypes is essential for long-term management; however, overlapping features among type 1 diabetes (T1D), type 2 diabetes (T2D), and maturity-onset diabetes of the young (MODY) complicate diagnosis. Clinical characteristics and temporal trends according to childhood-onset diabetes subtype were investigated over a 20-year period.
We retrospectively reviewed 662 patients diagnosed with T1D, T2D, or MODY at Seoul National University Children's Hospital between 2003 and 2022 at ages ≥6 months and <19 years, excluding secondary and other specific forms. Subtypes were classified based on autoantibody status, insulin dependence, adiposity, family history, and genetic testing.
Of patients, 477 (72.1%) had T1D, 143 (21.6%) had T2D, and 39 (5.9%) had MODY; 3 had coexisting T1D and MODY. Ten patients underwent diabetes subtype reclassification during follow-up. T1D was associated with more frequent diabetic ketoacidosis (DKA) and less family history than T2D or MODY (both P < 0.001). T2D showed higher BMI z-scores and a greater prevalence of overweight and obesity (both P < 0.001). The proportion of T2D increased over time (P for trend < 0.001), whereas MODY remained stable (P for trend = 0.116). Among 21 genetically confirmed MODY cases, GCK variants were the most common, followed by HNF1A variants.
Over the 20-year study period, the proportion of T2D increased among children and adolescents. Expanded insurance coverage for autoantibody testing, along with more affordable access to next-generation sequencing (NGS) panels when clinically indicated, may facilitate earlier and more accurate diagnosis and enable individualized treatment.
We retrospectively reviewed 662 patients diagnosed with T1D, T2D, or MODY at Seoul National University Children's Hospital between 2003 and 2022 at ages ≥6 months and <19 years, excluding secondary and other specific forms. Subtypes were classified based on autoantibody status, insulin dependence, adiposity, family history, and genetic testing.
Of patients, 477 (72.1%) had T1D, 143 (21.6%) had T2D, and 39 (5.9%) had MODY; 3 had coexisting T1D and MODY. Ten patients underwent diabetes subtype reclassification during follow-up. T1D was associated with more frequent diabetic ketoacidosis (DKA) and less family history than T2D or MODY (both P < 0.001). T2D showed higher BMI z-scores and a greater prevalence of overweight and obesity (both P < 0.001). The proportion of T2D increased over time (P for trend < 0.001), whereas MODY remained stable (P for trend = 0.116). Among 21 genetically confirmed MODY cases, GCK variants were the most common, followed by HNF1A variants.
Over the 20-year study period, the proportion of T2D increased among children and adolescents. Expanded insurance coverage for autoantibody testing, along with more affordable access to next-generation sequencing (NGS) panels when clinically indicated, may facilitate earlier and more accurate diagnosis and enable individualized treatment.