Predicting progression to diabetes in islet autoantibody positive children

Publication date: Available online 1 February 2018
Source:Journal of Autoimmunity
Author(s): Andrea K. Steck, Fran Dong, Brigitte I. Frohnert, Kathleen Waugh, Michelle Hoffman, Jill M. Norris, Marian J. Rewers
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.



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