Incident Dysglycemia and Progression to Type 1 Diabetes Among Participants in the Diabetes Prevention Trial–Type 1
- Jay M. Sosenko, MD1,
- Jerry P. Palmer, MD2,
- Lisa Rafkin-Mervis, MS, CDE1,
- Jeffrey P. Krischer, PHD3,
- David Cuthbertson, MS4,
- Jeffery Mahon, MD5,
- Carla J. Greenbaum, MD6,
- Catherine C. Cowie, PHD7,
- Jay S. Skyler, MD1 and
- the Diabetes Prevention Trial–Type 1 Study Group
- 1Division of Endocrinology, University of Miami, Miami, Florida;
- 2Division of Endocrinology/Metabolism, University of Washington, Seattle, Washington;
- 3Division of Informatics and Biostatistics, University of South Florida, Tampa, Florida;
- 4Pediatrics Epidemiology Center, University of South Florida, Tampa, Florida;
- 5Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada;
- 6Benaroya Research Institute at Virginia Mason, Seattle, Washington;
- 7National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
- Corresponding author: Jay M. Sosenko, jsosenko{at}med.miami.edu.
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 <13 years (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.
Footnotes
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- Received December 2, 2008.
- Accepted May 21, 2009.
