Incident Dysglycemia and Progression to Type 1 Diabetes Among Participants in the Diabetes Prevention Trial–Type 1
Open Access
- 1 June 2009
- journal article
- Published by American Diabetes Association in Diabetes Care
- Vol. 32 (9), 1603-1607
- https://doi.org/10.2337/dc08-2140
Abstract
OBJECTIVE We studied the incidence of dysglycemia and its prediction of the development of type 1 diabetes in islet cell autoantibody (ICA)-positive individuals. In addition, we assessed whether dysglycemia was sustained. RESEARCH DESIGN AND METHODS Participants (n = 515) in the Diabetes Prevention Trial–Type 1 (DPT-1) with normal glucose tolerance who underwent periodic oral glucose tolerance tests (OGTTs) were followed for incident dysglycemia (impaired fasting glucose, impaired glucose tolerance, and/or high glucose levels at intermediate time points of OGTTs). Incident dysglycemia at the 6-month visit was assessed for type 1 diabetes prediction. RESULTS Of 515 participants with a normal baseline OGTT, 310 (60%) had at least one episode of dysglycemia over a maximum follow-up of 7 years. Dysglycemia at the 6-month visit was highly predictive of the development of type 1 diabetes, both in those aged P < 0.001) and those aged ≥13 years (P < 0.01). Those aged <13 years with dysglycemia at the 6-month visit had a high cumulative incidence (94% estimate by 5 years). Among those who developed type 1 diabetes after a dysglycemic OGTT and who had at least two OGTTs after the dysglycemic OGTT, 33 of 64 (52%) reverted back to a normal OGTT. However, 26 (79%) of the 33 then had another dysglycemic OGTT before diagnosis. CONCLUSIONS ICA-positive individuals with normal glucose tolerance had a high incidence of dysglycemia. Incident dysglycemia in those who are ICA positive is strongly predictive of type 1 diabetes. Children with incident dysglycemia have an especially high risk. Fluctuations in and out of the dysglycemic state are not uncommon before the onset of type 1 diabetes.Keywords
This publication has 16 references indexed in Scilit:
- Glucose and C-Peptide Changes in the Perionset Period of Type 1 Diabetes in the Diabetes Prevention Trial–Type 1Diabetes Care, 2008
- Pre-Type 1 Diabetes Dysmetabolism: Maximal Sensitivity Achieved with Both Oral and Intravenous Glucose Tolerance TestingThe Journal of Pediatrics, 2007
- Increasing the Accuracy of Oral Glucose Tolerance Testing and Extending Its Application to Individuals With Normal Glucose Tolerance for the Prediction of Type 1 DiabetesDiabetes Care, 2007
- Patterns of Metabolic Progression to Type 1 Diabetes in the Diabetes Prevention Trial–Type 1Diabetes Care, 2006
- Natural History of β-Cell Function in Type 1 DiabetesDiabetes, 2005
- Effects of Oral Insulin in Relatives of Patients With Type 1 DiabetesDiabetes Care, 2005
- Effects of Insulin in Relatives of Patients with Type 1 Diabetes MellitusThe New England Journal of Medicine, 2002
- Homogeneity in Pattern of Decline of β-Cell Function in IDDM: Prospective study of 204 consecutive cases followed for 7.4 yrDiabetes Care, 1992
- Impaired glucose tolerance precedes but does not predict insulin-dependent diabetes mellitus: a study of identical twinsDiabetologia, 1990
- Ten-Year Prognosis of Impaired Glucose Tolerance in Siblings of Patients with Insulin-dependent DiabetesDiabetes, 1982