One-Hour Oral Glucose Tolerance Tests for the Prediction and Diagnostic Surveillance of Type 1 Diabetes

Abstract Context Once islet autoantibody–positive individuals are identified, predicting which individuals are at highest risk for type 1 diabetes (T1D) is important. A metabolic risk score derived from 2-hour oral glucose tolerance test (OGTT) data, the Diabetes Prevention Trial-Type 1 risk score (...

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Veröffentlicht in:The journal of clinical endocrinology and metabolism Jg. 105; H. 11; S. e4094 - e4101
Hauptverfasser: Simmons, Kimber M, Sosenko, Jay M, Warnock, Megan, Geyer, Susan, Ismail, Heba M, Elding Larsson, Helena, Steck, Andrea K
Format: Journal Article
Sprache:Englisch
Veröffentlicht: US Oxford University Press 01.11.2020
Copyright Oxford University Press
Schlagworte:
Adolescent
Adult
Autoantibodies
Autoantibodies - blood
Autoimmunity
Blood Glucose - metabolism
Body mass index
Child
Child, Preschool
Clinical s
Dextrose
Diabetes
Diabetes mellitus (insulin dependent)
Diabetes Mellitus, Type 1 - blood
Diabetes Mellitus, Type 1 - diagnosis
Diabetes Mellitus, Type 1 - immunology
Diagnosis
Disease Management
Female
Glucose
Glucose metabolism
Glucose tolerance
Glucose Tolerance Test
Humans
Infant
Male
Middle Aged
Peptides
Predictions
Prevention
Risk Assessment
Surveillance
Type 1 diabetes
Young Adult
prediction
diagnosis
type 1 diabetes
autoantibody
oral glucose tolerance test
metabolic risk
ISSN:0021-972X, 1945-7197, 1945-7197
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Zusammenfassung:Abstract Context Once islet autoantibody–positive individuals are identified, predicting which individuals are at highest risk for type 1 diabetes (T1D) is important. A metabolic risk score derived from 2-hour oral glucose tolerance test (OGTT) data, the Diabetes Prevention Trial-Type 1 risk score (DPTRS), can accurately predict T1D. However, 2-hour OGTTs are time-consuming and costly. Objective We aimed to determine whether a risk score derived from 1-hour OGTT data can predict T1D as accurately as the DPTRS. Secondarily, we evaluated whether a 1-hour glucose value can be used for diagnostic surveillance. Methods The DPTRS was modified to derive a 1-hour OGTT risk score (DPTRS60) using fasting C-peptide, 1-hour glucose and C-peptide, age, and body mass index. Areas under receiver operating curves (ROCAUCs) were used to compare prediction accuracies of DPTRS60 with DPTRS in Diabetes Prevention Trial–Type 1 (DPT-1) (n = 654) and TrialNet Pathway to Prevention (TNPTP) (n = 4610) participants. Negative predictive values (NPV) for T1D diagnosis were derived for 1-hour glucose thresholds. Results ROCAUCs for T1D prediction 5 years from baseline were similar between DPTRS60 and DPTRS (DPT-1: 0.805 and 0.794; TNPTP: 0.832 and 0.847, respectively). DPTRS60 predicted T1D significantly better than 2-hour glucose (P < .001 in both cohorts). A 1-hour glucose of less than 180 mg/dL had a similar NPV, positive predictive value, and specificity for T1D development before the next 6-month visit as the standard 2-hour threshold of less than 140 mg/dL (both ≥ 98.5%). Conclusion A 1-hour OGTT can predict T1D as accurately as a 2-hour OGTT with minimal risk of missing a T1D diagnosis before the next visit.
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ISSN:0021-972X
1945-7197
1945-7197
DOI:10.1210/clinem/dgaa592