Warncke, KatharinaTamura, RoySchatz, Desmond A.Veijola, RiittaSteck, Andrea K.Akolkar, BeenaHagopian, WilliamKrischer, Jeffrey P.Lernmark, ÅkeRewers, Marian J.Toppari, JormaMcIndoe, RichardZiegler, Anette-G.Vehik, KendraHaller, Michael J.Elding Larsson, Helena2024-08-262024-08-262024-05-24Warncke K, Tamura R, Schatz DA, et al. The Influence of Pubertal Development on Autoantibody Appearance and Progression to Type 1 Diabetes in the TEDDY Study. J Endocr Soc. 2024;8(7):bvae103. Published 2024 May 24. doi:10.1210/jendso/bvae103https://hdl.handle.net/1805/42949Context: The 2 peaks of type 1 diabetes incidence occur during early childhood and puberty. Objective: We sought to better understand the relationship between puberty, islet autoimmunity, and type 1 diabetes. Methods: The relationships between puberty, islet autoimmunity, and progression to type 1 diabetes were investigated prospectively in children followed in The Environmental Determinants of Diabetes in the Young (TEDDY) study. Onset of puberty was determined by subject self-assessment of Tanner stages. Associations between speed of pubertal progression, pubertal growth, weight gain, homeostasis model assessment of insulin resistance (HOMA-IR), islet autoimmunity, and progression to type 1 diabetes were assessed. The influence of individual factors was analyzed using Cox proportional hazard ratios. Results: Out of 5677 children who were still in the study at age 8 years, 95% reported at least 1 Tanner Stage score and were included in the study. Children at puberty (Tanner Stage ≥2) had a lower risk (HR 0.65, 95% CI 0.45-0.93; P = .019) for incident autoimmunity than prepubertal children (Tanner Stage 1). An increase of body mass index Z-score was associated with a higher risk (HR 2.88, 95% CI 1.61-5.15; P < .001) of incident insulin autoantibodies. In children with multiple autoantibodies, neither HOMA-IR nor rate of progression to Tanner Stage 4 were associated with progression to type 1 diabetes. Conclusion: Rapid weight gain during puberty is associated with development of islet autoimmunity. Puberty itself had no significant influence on the appearance of autoantibodies or type 1 diabetes. Further studies are needed to better understand the underlying mechanisms.en-USAttribution 4.0 InternationalDiabetesβ-cellInsulin resistanceType 1 diabetesArticle