Predicting progression to diabetes in islet autoantibody positive children

J Autoimmun. 2018 Jun;90:59-63. doi: 10.1016/j.jaut.2018.01.006. Epub 2018 Feb 1.

Abstract

While full oral glucose tolerance test (OGTT) helps improve prediction, it requires intravenous access with 6 sample collections for glucose and C-peptide. The objective of this study was to explore less costly and less time-consuming options. All children being prospectively followed by the Diabetes Autoimmunity Study in the Young (DAISY) who had a complete baseline OGTT and at least one confirmed islet autoantibody (Ab+) were included in this study (n = 68). Of 68 Ab+ subjects with a baseline OGTT, 25 developed diabetes after a mean follow-up 5.7 yrs, at a mean age of 12.4 yrs. Univariate proportional hazards (PH) models suggested that age at seroconversion, number of Ab+, IA-2A levels, HbA1c and metabolic variables from the OGTT predicted progression to diabetes, while HLA DR3/4, BMI, levels of IAA or GADA did not. Five multivariate PH predictive models were similar (p = 0.32). All five models included age at seroconversion, number of Ab+, IA-2A levels and HbA1c, and in addition included: model 1 - 1 h glucose and 1 h C-peptide; model 2 - 2 h glucose and 2 h C-peptide; model 3 - glucose sum and C-peptide sum; model 4 - glucose AUC and C-peptide AUC; and model 5: index 60. A model containing age at seroconversion, number of Ab+, IA-2A levels, HbA1c, 1 h glucose and 1 h C-peptide was as predictive for type 1 diabetes progression as models including all sum or AUC values for glucose and C-peptide from full OGTT. The performance of this model should be confirmed in an independent population of Ab+ children.

Keywords: Islet autoimmunity; Oral glucose tolerance test; Predictors for diabetes; Progression to diabetes; Type 1 diabetes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Autoantibodies / blood*
  • C-Reactive Protein / metabolism
  • Child
  • Diabetes Mellitus, Type 1 / diagnosis*
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Glucose Tolerance Test
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Islets of Langerhans / immunology*
  • Male
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies

Substances

  • Autoantibodies
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human
  • C-Reactive Protein