HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Online-Only Appendix All Versions of this Article: dc06-2389v1 30/9/2314    most recent Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Xu, P. Search for Related Content PubMed PubMed Citation Articles by Xu, P. Social Bookmarking                What's this?

Role of Insulin Resistance in Predicting Progression to Type 1 Diabetes

¹ Pediatrics Epidemiology Center, University of South Florida, Tampa, Florida
² Benaroya Research Institute at Virginia Mason, Seattle, Washington
³ Veterans Affairs Puget Sound, University of Washington, Seattle, Washington

Address correspondence and reprint requests to Jeffrey P. Krischer, Division of Informatics and Biostatistics, Pediatrics Epidemiology Center, University of South Florida, 3650 Spectrum Blvd., Suite 100, Tampa, FL 33612. E-mail: jpkrischer{at}epi.usf.edu

OBJECTIVE—The purpose of this study was to determine whether insulin resistance is a risk factor for the development of type 1 diabetes in autoantibody-positive first-degree relatives of diabetic family members.

RESEARCH DESIGN AND METHODS—Subjects (n = 186) who had a projected 25–50% risk for diabetes and subjects (n = 170) who had a projected >50% risk for type 1 diabetes in 5 years were followed until clinical diabetes onset or the end of the study as part of the Diabetes Prevention Trial–Type 1. We assessed insulin secretion with the first-phase insulin response (FPIR) and insulin resistance with homeostasis model assessment of insulin resistance (HOMA-IR) from an intravenous glucose tolerance test. The median follow-up was 4.3 years for moderate-risk subjects and 3.7 years for high-risk subjects.

RESULTS—During the follow-up period, 53 subjects in the moderate-risk group and 70 subjects in the high-risk group developed type 1 diabetes. After adjustments for confounders using multivariate analysis, HOMA-IR and the FPIR–to–HOMA-IR ratio were significantly associated with type 1 diabetes in both risk groups. In the moderate-risk population, the hazard ratio (HR) of HOMA-IR was 2.70 (95% CI 1.45–5.06) and the HR of FPIR-to-HOMA-IR was 0.32 (95% CI 0.18–0.57). In the high-risk population, the HR of HOMA-IR was 1.83 (95% CI 1.19–2.82) and the HR of FPIR–to–HOMA-IR was 0.56 (95% CI 0.40–0.78).

CONCLUSIONS—There is clear evidence of the association between insulin resistance and progression to type 1 diabetes. The combination of FPIR and HOMA-IR could be used as a better metabolic indicator for type 1 diabetes risk for prediction and suggests possible intervention strategies for diabetes prevention.

Abbreviations: DPT-1, Diabetes Prevention Trial–Type 1 • FPIR, first-phase insulin response • HOMA-IR, homeostasis model assessment of insulin resistance • IAA, insulin autoantibody • ICA, islet cell antibody • IVGTT, intravenous glucose tolerance test • OGTT, oral glucose tolerance test

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				M. M. Lamb, X. Yin, K. Barriga, M. R. Hoffman, A. E. Baron, G. S. Eisenbarth, M. Rewers, and J. M. Norris Dietary Glycemic Index, Development of Islet Autoimmunity, and Subsequent Progression to Type 1 Diabetes in Young Children J. Clin. Endocrinol. Metab., October 1, 2008; 93(10): 3936 - 3942. [Abstract] [Full Text] [PDF]

				J. M. Sosenko, J. P. Krischer, J. P. Palmer, J. Mahon, C. Cowie, C. J. Greenbaum, D. Cuthbertson, J. M. Lachin, J. S. Skyler, and the Diabetes Prevention Trial-Type 1 Study Group A Risk Score for Type 1 Diabetes Derived From Autoantibody-Positive Participants in the Diabetes Prevention Trial-Type 1 Diabetes Care, March 1, 2008; 31(3): 528 - 533. [Abstract] [Full Text] [PDF]