July 22, 2025

Contrasting Adult vs. Pediatric populations in a cohort of at risk relatives: The TrialNet Pathway to Prevention Study

Key Points

Adults showed a higher rate of single autoantibody positivity at 4.0%, compared to 2.6% in children.
Progression risks to stage 3 disease were significantly lower for adults than for children, with 8.2% vs 22% respectively.
Autoantibody-positive adults exhibited distinct trajectories and a higher rate of single autoantibody positivity at 40% than children.
HbA1c and established risk indices were more effective in identifying progressors in adults compared to children.

Abstract

ObjectiveAdults represent over half of incident type 1 diabetes, yet research on disease progression predominantly focuses on at-risk children. We aimed to compare autoantibody screening outcomes and type 1 diabetes progression in adults versus children.Research Design and MethodsWe studied 135,914 children (ResultsAdults were more likely than children to screen positive for a single autoantibody (4.0% vs 2.6%) but less likely for multiple autoantibodies (0.83% vs 2.8%; pConclusionAutoantibody-positive adult relatives exhibit distinct autoantibody trajectories and progression risks compared to children, suggesting the need for tailored monitoring and intervention strategies.

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