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

Simmons, Kimber M. ; Sosenko, Jay M. ; Warnock, Megan ; Geyer, Susan ; Ismail, Heba M. ; Elding Larsson, Helena LU and Steck, Andrea K. (2020) In The Journal of clinical endocrinology and metabolism 105(11).
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,... (More)

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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author
; ; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
subject
keywords
autoantibody, diagnosis, metabolic risk, oral glucose tolerance test, prediction, type 1 diabetes
in
The Journal of clinical endocrinology and metabolism
volume
105
issue
11
publisher
Oxford University Press
external identifiers
  • scopus:85091691945
  • pmid:32844178
ISSN
1945-7197
DOI
10.1210/clinem/dgaa592
language
English
LU publication?
no
id
32e7c52e-d6cb-4e27-94fa-cefcc58b00c3
date added to LUP
2020-10-23 12:32:48
date last changed
2024-06-28 02:09:07
@article{32e7c52e-d6cb-4e27-94fa-cefcc58b00c3,
  abstract     = {{<p>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 &lt; .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.</p>}},
  author       = {{Simmons, Kimber M. and Sosenko, Jay M. and Warnock, Megan and Geyer, Susan and Ismail, Heba M. and Elding Larsson, Helena and Steck, Andrea K.}},
  issn         = {{1945-7197}},
  keywords     = {{autoantibody; diagnosis; metabolic risk; oral glucose tolerance test; prediction; type 1 diabetes}},
  language     = {{eng}},
  month        = {{11}},
  number       = {{11}},
  publisher    = {{Oxford University Press}},
  series       = {{The Journal of clinical endocrinology and metabolism}},
  title        = {{One-Hour Oral Glucose Tolerance Tests for the Prediction and Diagnostic Surveillance of Type 1 Diabetes}},
  url          = {{http://dx.doi.org/10.1210/clinem/dgaa592}},
  doi          = {{10.1210/clinem/dgaa592}},
  volume       = {{105}},
  year         = {{2020}},
}