331-OR: Clinical and Immunologic Features Differ in Children at Type 1 Diabetes Onset by Ethnicity

Introduction & Objective: Type 1 diabetes (T1D) incidence continues to increase in children, especially among Hispanic Whites (HW). We investigated the clinical and immunologic characteristics of HW and Non-Hispanic White (NHW) children that presented at T1D diagnosis over the last two decades to the Barbara Davis Center for Diabetes. Methods: In this single-center, observational study, children who were diagnosed with T1D ( < 20 years old) and tested for islet autoantibodies within 1 year of diagnosis were included and divided into two groups by ethnicity. Results: Of 1256 children, 401 HW children presented with a younger age at T1D onset, and more DKA compared to NHW children (n=855) (Table 1). There was no difference in sex, HbA1c levels, or the number and prevalence of islet autoantibodies between the two cohorts. A subset of our cohort was HLA-DR-DQ typed as specific alleles confer strong genetic risk for T1D (e.g., HLA-DR4 and DQ8). Among 556 HLA-typed children, HW children had a significantly higher prevalence of the DR4-DQ8 haplotype compared to NHW children (75.8% vs. 59.0%, p=0.002). Moreover, DR3-DQ2 was lower in HW compared to NHW T1D children (29.8% vs. 47.1%, p=0.001). Conclusion: Hispanic White children developing T1D have a strikingly high prevalence of HLA DR4-DQ8, which can be utilized in screening for T1D risk to lessen DKA and potentially prevent diabetes onset.