{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:54:33Z","timestamp":1792482873324,"version":"4.5.0"},"reference-count":55,"publisher":"American Diabetes Association","issue":"4","license":[{"start":{"date-parts":[[2021,3,19]],"date-time":"2021-03-19T00:00:00Z","timestamp":1616112000000},"content-version":"vor","delay-in-days":65,"URL":"https:\/\/www.diabetesjournals.org\/content\/license"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P01 AI042288"],"award-info":[{"award-number":["P01 AI042288"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["DP3 DK101120-01"],"award-info":[{"award-number":["DP3 DK101120-01"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008871","name":"JDRF","doi-asserted-by":"publisher","award":["1-SRA-2019-764-A-N"],"award-info":[{"award-number":["1-SRA-2019-764-A-N"]}],"id":[{"id":"10.13039\/100008871","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Jeffrey Keene Family Professorship"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,4,1]]},"abstract":"<jats:p>Exocrine pancreas abnormalities are increasingly recognized as features of type 1 diabetes. We previously reported reduced serum trypsinogen levels and in a separate study, smaller pancreata at and before disease onset. We hypothesized that three pancreas enzymes (amylase, lipase, and trypsinogen) might serve as serological biomarkers of pancreas volume and risk for type 1 diabetes. Amylase, lipase, and trypsinogen were measured from two independent cohorts, together comprising 800 serum samples from single-autoantibody\u2013positive (1AAb+) and multiple-AAb+ (\u22652AAb+) subjects, individuals with recent-onset or established type 1 diabetes, their AAb-negative (AAb\u2212) first-degree relatives, and AAb\u2212 control subjects. Lipase and trypsinogen were significantly reduced in \u22652AAb+, recent-onset, and established type 1 diabetes subjects versus control subjects and 1AAb+, while amylase was reduced only in established type 1 diabetes. Logistic regression models demonstrated trypsinogen plus lipase (area under the receiver operating characteristic curve [AUROC] = 81.4%) performed equivalently to all three enzymes (AUROC = 81.4%) in categorizing \u22652AAb+ versus 1AAb+ subjects. For cohort 2 (n = 246), linear regression demonstrated lipase and trypsinogen levels could individually and collectively serve as indicators of BMI-normalized relative pancreas volume (RPVBMI, P &amp;lt; 0.001), previously measured by MRI. Serum lipase and trypsinogen levels together provide the most sensitive serological biomarker of RPVBMI and may improve disease staging in pretype 1 diabetes.<\/jats:p>","DOI":"10.2337\/db20-0995","type":"journal-article","created":{"date-parts":[[2021,1,13]],"date-time":"2021-01-13T16:35:34Z","timestamp":1610555734000},"page":"944-954","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":42,"title":["Exocrine Pancreatic Enzymes Are a Serological Biomarker for Type 1 Diabetes Staging and Pancreas Size"],"prefix":"10.2337","volume":"70","clinical-trial-number":[{"clinical-trial-number":"nct02234947","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02234947","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02234947","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"James J.","family":"Ross","sequence":"first","affiliation":[{"name":"Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clive H.","family":"Wasserfall","sequence":"additional","affiliation":[{"name":"Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhonda","family":"Bacher","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, College of Medicine, University of Florida, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Perry","sequence":"additional","affiliation":[{"name":"Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieran","family":"McGrail","sequence":"additional","affiliation":[{"name":"Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda L.","family":"Posgai","sequence":"additional","affiliation":[{"name":"Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoru","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, College of Medicine, University of Florida, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Muir","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emory University, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China"},{"name":"National Clinical Research Center for Metabolic Diseases, Changsha, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Campbell-Thompson","sequence":"additional","affiliation":[{"name":"Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL"},{"name":"Department of Biomedical Engineering, College of Engineering, University of Florida, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd M.","family":"Brusko","sequence":"additional","affiliation":[{"name":"Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL"},{"name":"Department of Pediatrics, University of Florida Diabetes Institute, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desmond A.","family":"Schatz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Florida Diabetes Institute, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Haller","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Florida Diabetes Institute, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8489-4782","authenticated-orcid":false,"given":"Mark A.","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL"},{"name":"Department of Pediatrics, University of Florida Diabetes Institute, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2021,1,13]]},"reference":[{"key":"2022031302164492700_B1","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1084\/jem.11.2.266","article-title":"A study of the pathological anatomy of the pancreas in ninety cases of diabetes mellitus","volume":"11","author":"Cecil","year":"1909","journal-title":"J Exp Med"},{"key":"2022031302164492700_B2","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1136\/gut.22.2.158","article-title":"The pancreas as a single organ: the influence of the endocrine upon the exocrine part of the gland","volume":"22","author":"Henderson","year":"1981","journal-title":"Gut"},{"key":"2022031302164492700_B3","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1007\/BF00275740","article-title":"Residual insulin positivity and pancreatic atrophy in relation to duration of chronic type 1 (insulin-dependent) diabetes mellitus and microangiopathy","volume":"30","author":"L\u00f6hr","year":"1987","journal-title":"Diabetologia"},{"key":"2022031302164492700_B4","doi-asserted-by":"crossref","first-page":"619","DOI":"10.2337\/diab.14.10.619","article-title":"Pathologic anatomy of the pancreas in juvenile diabetes mellitus","volume":"14","author":"Gepts","year":"1965","journal-title":"Diabetes"},{"key":"2022031302164492700_B5","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1369\/0022155418778546","article-title":"Islet microvasculature alterations with loss of beta-cells in patients with type 1 diabetes","volume":"67","author":"Canzano","year":"2019","journal-title":"J Histochem Cytochem"},{"key":"2022031302164492700_B6","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1016\/j.neuron.2017.02.005","article-title":"New horizons in diabetic neuropathy: mechanisms, bioenergetics, and pain","volume":"93","author":"Feldman","year":"2017","journal-title":"Neuron"},{"key":"2022031302164492700_B7","doi-asserted-by":"crossref","first-page":"17016","DOI":"10.1038\/nrdp.2017.16","article-title":"Type 1 diabetes mellitus","volume":"3","author":"Katsarou","year":"2017","journal-title":"Nat Rev Dis Primers"},{"key":"2022031302164492700_B8","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1172\/JCI44339","article-title":"Noninvasive imaging of pancreatic islet inflammation in type 1A diabetes patients","volume":"121","author":"Gaglia","year":"2011","journal-title":"J Clin Invest"},{"key":"2022031302164492700_B9","doi-asserted-by":"crossref","first-page":"E2109","DOI":"10.1210\/jc.2012-1815","article-title":"Pancreatic volume is reduced in adult patients with recently diagnosed type 1 diabetes","volume":"97","author":"Williams","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"2022031302164492700_B10","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1007\/s00125-015-3752-z","article-title":"The influence of type 1 diabetes on pancreatic weight","volume":"59","author":"Campbell-Thompson","year":"2016","journal-title":"Diabetologia"},{"key":"2022031302164492700_B11","doi-asserted-by":"crossref","first-page":"281","DOI":"10.2337\/dc18-1512","article-title":"Relative pancreas volume is reduced in first-degree relatives of patients with type 1 diabetes","volume":"42","author":"Campbell-Thompson","year":"2019","journal-title":"Diabetes Care"},{"key":"2022031302164492700_B12","doi-asserted-by":"crossref","first-page":"248","DOI":"10.2337\/dc18-1507","article-title":"Pancreas volume declines during the first year after diagnosis of type 1 diabetes and exhibits altered diffusion at disease onset","volume":"42","author":"Virostko","year":"2019","journal-title":"Diabetes Care"},{"key":"2022031302164492700_B13","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1507\/endocrj.44.23","article-title":"Histopathologic study of the pancreas shows a characteristic lymphocytic infiltration in Japanese patients with IDDM","volume":"44","author":"Waguri","year":"1997","journal-title":"Endocr J"},{"key":"2022031302164492700_B14","doi-asserted-by":"crossref","first-page":"2072","DOI":"10.2337\/db12-1345","article-title":"Reduction of circulating neutrophils precedes and accompanies type 1 diabetes","volume":"62","author":"Valle","year":"2013","journal-title":"Diabetes"},{"key":"2022031302164492700_B15","doi-asserted-by":"crossref","first-page":"3880","DOI":"10.2337\/db14-0549","article-title":"Increased immune cell infiltration of the exocrine pancreas: a possible contribution to the pathogenesis of type 1 diabetes","volume":"63","author":"Rodriguez-Calvo","year":"2014","journal-title":"Diabetes"},{"key":"2022031302164492700_B16","doi-asserted-by":"crossref","first-page":"3815","DOI":"10.2337\/dc13-0203","article-title":"Increased complement activation in human type 1 diabetes pancreata","volume":"36","author":"Rowe","year":"2013","journal-title":"Diabetes Care"},{"key":"2022031302164492700_B17","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1007\/s00125-020-05155-y","article-title":"Decreased pancreatic acinar cell number in type 1 diabetes","volume":"63","author":"Wright","year":"2020","journal-title":"Diabetologia"},{"key":"2022031302164492700_B18","doi-asserted-by":"crossref","first-page":"60","DOI":"10.2337\/db19-0554","article-title":"Temporal analysis of amylase expression in control, autoantibody-positive, and type 1 diabetes pancreatic tissues","volume":"69","author":"Kusmartseva","year":"2020","journal-title":"Diabetes"},{"key":"2022031302164492700_B19","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1001\/jama.2012.15008","article-title":"Pancreas organ weight in individuals with disease-associated autoantibodies at risk for type 1 diabetes","volume":"308","author":"Campbell-Thompson","year":"2012","journal-title":"JAMA"},{"key":"2022031302164492700_B20","doi-asserted-by":"crossref","first-page":"577","DOI":"10.2337\/dc16-1774","article-title":"Serum trypsinogen levels in type 1 diabetes","volume":"40","author":"Li","year":"2017","journal-title":"Diabetes Care"},{"key":"2022031302164492700_B21","doi-asserted-by":"crossref","first-page":"107974","DOI":"10.1016\/j.diabres.2019.107974","article-title":"Low serum amylase, lipase, and trypsin as biomarkers of metabolic disorders: a systematic review and meta-analysis","volume":"159","author":"Ko","year":"2020","journal-title":"Diabetes Res Clin Pract"},{"key":"2022031302164492700_B22","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/cei.12797","article-title":"Validation of a rapid type 1 diabetes autoantibody screening assay for community-based screening of organ donors to identify subjects at increased risk for the disease","volume":"185","author":"Wasserfall","year":"2016","journal-title":"Clin Exp Immunol"},{"key":"2022031302164492700_B23","first-page":"57","article-title":"Islet autoantibody analysis: radioimmunoassays","volume-title":"Type 1 Diabetes","author":"Wyatt","year":"2016"},{"key":"2022031302164492700_B24","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1093\/clinchem\/34.10.2005","article-title":"Development of a direct assay for alpha-amylase","volume":"34","author":"Winn-Deen","year":"1988","journal-title":"Clin Chem"},{"key":"2022031302164492700_B25","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1093\/clinchem\/38.2.211","article-title":"Kinetic colorimetric assay of lipase in serum","volume":"38","author":"Fossati","year":"1992","journal-title":"Clin Chem"},{"key":"2022031302164492700_B26","doi-asserted-by":"crossref","first-page":"1964","DOI":"10.2337\/dc15-1419","article-title":"Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association","volume":"38","author":"Insel","year":"2015","journal-title":"Diabetes Care"},{"key":"2022031302164492700_B27","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1093\/geronj\/42.3.315","article-title":"Human serum pancreatic lipase and trypsin 1 in aging: enzymatic and immunoenzymatic assays","volume":"42","author":"Carrere","year":"1987","journal-title":"J Gerontol"},{"key":"2022031302164492700_B28","first-page":"CD012010","article-title":"Serum amylase and lipase and urinary trypsinogen and amylase for diagnosis of acute pancreatitis","volume":"4","author":"Rompianesi","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"2022031302164492700_B29","first-page":"2757","article-title":"Mechanism and role of trypsinogen activation in acute pancreatitis","volume":"46","author":"Mayer","year":"1999","journal-title":"Hepatogastroenterology"},{"key":"2022031302164492700_B30","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1136\/gut.27.11.1362","article-title":"Serum immunoreactive cationic trypsinogen: a useful indicator of severe exocrine dysfunction in the paediatric patient without cystic fibrosis","volume":"27","author":"Moore","year":"1986","journal-title":"Gut"},{"key":"2022031302164492700_B31","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/BF01237787","article-title":"Exocrine pancreatic function in juvenile diabetics","volume":"20","author":"Domschke","year":"1975","journal-title":"Am J Dig Dis"},{"key":"2022031302164492700_B32","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1136\/gut.17.9.685","article-title":"Exocrine pancreatic function in juvenile-onset diabetes mellitus","volume":"17","author":"Frier","year":"1976","journal-title":"Gut"},{"key":"2022031302164492700_B33","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1136\/jcp.33.11.1102","article-title":"Serum isoamylase activities in diabetes mellitus","volume":"33","author":"Foo","year":"1980","journal-title":"J Clin Pathol"},{"key":"2022031302164492700_B34","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1136\/jcp.36.2.200","article-title":"Low pancreatic lipase in insulin-dependent diabetics","volume":"36","author":"Junglee","year":"1983","journal-title":"J Clin Pathol"},{"key":"2022031302164492700_B35","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1007\/s13142-016-0386-8","article-title":"Statistical methodologies to pool across multiple intervention studies","volume":"6","author":"Bangdiwala","year":"2016","journal-title":"Transl Behav Med"},{"key":"2022031302164492700_B36","doi-asserted-by":"crossref","first-page":"e71","DOI":"10.2337\/dc14-2751","article-title":"Pancreatic amylase and lipase plasma concentrations are unaffected by increments in endogenous GLP-1 levels following liquid meal tests","volume":"38","author":"Sonne","year":"2015","journal-title":"Diabetes Care"},{"key":"2022031302164492700_B37","first-page":"11","article-title":"Basal and stimulated serum immunoreactive trypsin in normal subjects","volume":"62","author":"Bonora","year":"1980","journal-title":"Scand J Gastroenterol Suppl"},{"key":"2022031302164492700_B38","doi-asserted-by":"crossref","first-page":"839","DOI":"10.2337\/dc16-2684","article-title":"Impact of liraglutide on amylase, lipase, and acute pancreatitis in participants with overweight\/obesity and normoglycemia, prediabetes, or type 2 diabetes: secondary analyses of pooled data from the SCALE clinical development program","volume":"40","author":"Steinberg","year":"2017","journal-title":"Diabetes Care"},{"key":"2022031302164492700_B39","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1111\/pedi.13056","article-title":"Changes in pancreatic exocrine function in young at-risk children followed to islet autoimmunity and type 1 diabetes in the ENDIA study","volume":"21","author":"Penno","year":"2020","journal-title":"Pediatr Diabetes"},{"key":"2022031302164492700_B40","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1177\/2050640619828185","article-title":"The compliance rate for the second diagnostic evaluation after a positive fecal occult blood test: a systematic review and meta-analysis","volume":"7","author":"Gingold-Belfer","year":"2019","journal-title":"United European Gastroenterol J"},{"key":"2022031302164492700_B41","doi-asserted-by":"crossref","first-page":"3193","DOI":"10.2337\/diacare.26.11.3193","article-title":"Serum amylase and lipase in diabetic ketoacidosis","volume":"26","author":"Rizvi","year":"2003","journal-title":"Diabetes Care"},{"key":"2022031302164492700_B42","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1111\/pedi.12904","article-title":"No acute pancreatitis but reduced exocrine pancreatic function at diagnosis of type 1 diabetes in children","volume":"20","author":"Ludvigsson","year":"2019","journal-title":"Pediatr Diabetes"},{"key":"2022031302164492700_B43","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1111\/pedi.12592","article-title":"Exocrine pancreas function decreases during the progression of the beta-cell damaging process in young prediabetic children","volume":"19","author":"Kondrashova","year":"2018","journal-title":"Pediatr Diabetes"},{"key":"2022031302164492700_B44","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1097\/MPA.0000000000000609","article-title":"Diabetes mellitus is associated with an exocrine pancreatopathy: conclusions from a review of literature","volume":"45","author":"Mohapatra","year":"2016","journal-title":"Pancreas"},{"key":"2022031302164492700_B45","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.diabres.2005.07.003","article-title":"Pancreatic exocrine and endocrine events occur concomitantly but independently during the course of fulminant type 1 diabetes","volume":"71","author":"Kahara","year":"2006","journal-title":"Diabetes Res Clin Pract"},{"key":"2022031302164492700_B46","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1111\/jdi.12816","article-title":"Analysis of pancreatic volume in acute-onset, slowly-progressive and fulminant type 1 diabetes in a Japanese population","volume":"9","author":"Sasamori","year":"2018","journal-title":"J Diabetes Investig"},{"key":"2022031302164492700_B47","doi-asserted-by":"crossref","first-page":"528","DOI":"10.2337\/dc07-1459","article-title":"A risk score for type 1 diabetes derived from autoantibody-positive participants in the diabetes prevention trial-type 1","volume":"31","author":"Sosenko","year":"2008","journal-title":"Diabetes Care"},{"key":"2022031302164492700_B48","doi-asserted-by":"crossref","first-page":"271","DOI":"10.2337\/dc14-1813","article-title":"A new approach for diagnosing type 1 diabetes in autoantibody-positive individuals based on prediction and natural history","volume":"38","author":"Sosenko","year":"2015","journal-title":"Diabetes Care"},{"key":"2022031302164492700_B49","doi-asserted-by":"crossref","first-page":"200","DOI":"10.2337\/dc18-1785","article-title":"Development and standardization of an improved type 1 diabetes genetic risk score for use in newborn screening and incident diagnosis","volume":"42","author":"Sharp","year":"2019","journal-title":"Diabetes Care"},{"key":"2022031302164492700_B50","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.2337\/dc18-0087","article-title":"A type 1 diabetes genetic risk score predicts progression of islet autoimmunity and development of type 1 diabetes in individuals at risk","volume":"41","author":"Redondo","year":"2018","journal-title":"Diabetes Care"},{"key":"2022031302164492700_B51","doi-asserted-by":"crossref","first-page":"e1002548","DOI":"10.1371\/journal.pmed.1002548","article-title":"Genetic scores to stratify risk of developing multiple islet autoantibodies and type 1 diabetes: a prospective study in children","volume":"15","author":"Bonifacio","year":"2018","journal-title":"PLoS Med"},{"key":"2022031302164492700_B52","doi-asserted-by":"crossref","first-page":"4529","DOI":"10.1038\/s41598-018-22574-5","article-title":"Application of a genetic risk score to racially diverse type 1 diabetes populations demonstrates the need for diversity in risk-modeling","volume":"8","author":"Perry","year":"2018","journal-title":"Sci Rep"},{"key":"2022031302164492700_B53","doi-asserted-by":"crossref","first-page":"413","DOI":"10.2337\/db19-0942","article-title":"Insulin-like growth factor dysregulation both preceding and following type 1 diabetes diagnosis","volume":"69","author":"Shapiro","year":"2020","journal-title":"Diabetes"},{"key":"2022031302164492700_B54","doi-asserted-by":"crossref","first-page":"5","DOI":"10.2337\/dc19-0880","article-title":"Introducing the endotype concept to address the challenge of disease heterogeneity in type 1 diabetes","volume":"43","author":"Battaglia","year":"2020","journal-title":"Diabetes Care"},{"key":"2022031302164492700_B55","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1038\/s41591-020-0930-4","article-title":"A combined risk score enhances prediction of type 1 diabetes among susceptible children","volume":"26","author":"Ferrat","year":"2020","journal-title":"Nat Med"}],"container-title":["Diabetes"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/diabetes.diabetesjournals.org\/syndication\/doi\/10.2337\/db20-0995","content-type":"unspecified","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.org\/diabetes\/diabetes\/article-pdf\/70\/4\/944\/436101\/db200995.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/diabetes\/article-pdf\/70\/4\/944\/436101\/db200995.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T12:41:27Z","timestamp":1667392887000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/diabetes\/article\/70\/4\/944\/39277\/Exocrine-Pancreatic-Enzymes-Are-a-Serological"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,13]]},"references-count":55,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,1,13]]},"published-print":{"date-parts":[[2021,4,1]]}},"URL":"https:\/\/doi.org\/10.2337\/db20-0995","relation":{"has-preprint":[{"id-type":"doi","id":"10.2337\/figshare.13516922","asserted-by":"object"},{"id-type":"doi","id":"10.2337\/figshare.13516922.v1","asserted-by":"object"}]},"ISSN":["0012-1797","1939-327X"],"issn-type":[{"value":"0012-1797","type":"print"},{"value":"1939-327X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,13]]}}}