{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T16:00:06Z","timestamp":1786982406217,"version":"build-2736575974"},"reference-count":43,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T00:00:00Z","timestamp":1766793600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T00:00:00Z","timestamp":1766793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Nature Science Foundation of China","doi-asserted-by":"crossref","award":["82170910"],"award-info":[{"award-number":["82170910"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"2024-National Clinical Key Specialty Construction Project","award":["No.10000015Z155080000004"],"award-info":[{"award-number":["No.10000015Z155080000004"]}]},{"name":"Clinical Youth Cadre Hospital Fund of Shanghai Children's Medical Center","award":["QN-SCMC2023-5"],"award-info":[{"award-number":["QN-SCMC2023-5"]}]},{"name":"Special Fund for People's Livelihood Scientific Research of Public Institutions under the Science and Technology Development Fund of Pudong New Area","award":["PKJ2025-Y03"],"award-info":[{"award-number":["PKJ2025-Y03"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Pediatr"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Type 1 diabetes mellitus is a heterogeneous autoimmune disease with diverse characteristics between ethnicities and ages. Understanding this heterogeneity is essential for optimizing management and developing precision treatments. This study investigates the clinical, metabolic and immunological heterogeneity of type 1 diabetes mellitus in children across different ages of onset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis of 401 children newly diagnosed with type 1 diabetes mellitus at a single center from January 2009 to August 2024 was conducted. We compared the clinical characteristics of our cohort with others from different countries. Patients were categorized into three age groups: 6\u00a0months\u20135\u00a0years, 5\u201310\u00a0years and\u2009\u2265\u200910\u00a0years at diagnosis. Clinical, metabolic, and immunological features were compared among groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median cohort age was 8.58\u00a0years; 48.9% were male. Diabetic ketoacidosis occurred in 56.1% of patients, higher than in the Finnish and American cohorts. Most clinical characteristics are not significantly different among age groups. The 6\u00a0months\u20135\u00a0years group had a lower area under the curve (AUC) for C-peptide compared to the other age groups. The\u2009\u2265\u200910\u00a0years group was more likely to be thyroid antibody positive and have vitamin D deficiency. Immunologically, type 1 diabetes mellitus patients showed significantly increased counts of T lymphocytes, CD3\u2009+\u2009CD8\u2009+\u2009T cells and B lymphocytes, along with decreased interleukin-2 and increased interleukin-6 levels compared to healthy controls. Of note, the 6\u00a0months\u20135\u00a0years group had a higher CD4\/CD8 ratio, which was negatively correlated with C-peptide AUC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Significant heterogeneity in type 1 diabetes mellitus features exists across age groups. Early-onset patients showed poorer islet function and late-onset patients were more prone to metabolic complications. Collectively our study emphasizes the need for age-specific management strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s12519-025-01004-3","type":"journal-article","created":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T11:19:15Z","timestamp":1766834355000},"page":"247-257","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Age-related heterogeneity of type 1 diabetes mellitus in children: a single-center retrospective study"],"prefix":"10.1007","volume":"22","author":[{"given":"Shi-Yang","family":"Gao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Guo","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Bo","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian-Wen","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guo-Ying","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei-Han","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2186-759X","authenticated-orcid":false,"given":"Xiu-Min","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,27]]},"reference":[{"key":"1004_CR1","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1016\/S0140-6736(23)00223-4","volume":"401","author":"T Quattrin","year":"2023","unstructured":"Quattrin T, Mastrandrea LD, Walker LSK. 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Author Guo-Ying Chang serves as an Youth Editorial Board Member for\n                      World Journal of Pediatrics\n                      . The manuscript was handled by an independent Editor and underwent rigorous peer review. Author Guo-Ying Chang was excluded from all editorial decisions related to this manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was approved by the Research Ethics Committee of Shanghai Children\u2019s Medical Center (SCMCIRB-K2022007-1), School of Medicine, Shanghai Jiao Tong University and all methods were performed in accordance with the relevant guidelines and regulations (Declaration of Helsinki). Written informed consent was obtained from all participants or their guardians.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}