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- Title
Index60 Is Superior to HbA1c for Identifying Individuals at High Risk for Type 1 Diabetes.
- Authors
Jacobsen, Laura M.; Bundy, Brian N.; Ismail, Heba M.; Clements, Mark; Warnock, Megan; Geyer, Susan; Schatz, Desmond A.; Sosenko, Jay M.
- Abstract
Context: HbA1c from = 5.7% to < 6.5% (39-46 mmol/mol) indicates prediabetes according to American Diabetes Association guidelines, yet its identification of prediabetes specific for type 1 diabetes has not been assessed. A composite glucose and C-peptide measure, Index60, identifies individuals at high risk for type 1 diabetes. Objective: We compared Index60 and HbA1c thresholds as markers for type 1 diabetes risk. Methods: TrialNet Pathway to Prevention study participants with = 2 autoantibodies (GADA, IAA, IA-2A, or ZnT8A) who had oral glucose tolerance tests and HbA1c measurements underwent 1) predictive time-dependent modeling of type 1 diabetes risk (n = 2776); and 2) baseline comparisons between high-risk mutually exclusive groups: Index60 = 2.04 (n = 268) vs HbA1c = 5.7% (n = 268). The Index60 = 2.04 threshold was commensurate in ordinal ranking with the standard prediabetes threshold of HbA1c = 5.7%. Results: In mutually exclusive groups, individuals exceeding Index60 = 2.04 had a higher cumulative incidence of type 1 diabetes than those exceeding HbA1c = 5.7% (P < 0.0001). Appreciably more individuals with Index60 = 2.04 were at stage 2, and among those at stage 2, the cumulative incidence was higher for those with Index60 = 2.04 (P = 0.02). Those with Index60 = 2.04 were younger, with lower BMI, greater autoantibody number, and lower C-peptide than those with HbA1c = 5.7% (P < 0.0001 for all comparisons). Conclusion: Individuals with Index60 = 2.04 are at greater risk for type 1 diabetes with features more characteristic of the disorder than those with HbA1c = 5.7%. Index60 = 2.04 is superior to the standard HbA1c = 5.7% threshold for identifying prediabetes in autoantibody-positive individuals. These findings appear to justify using Index60 = 2.04 as a prediabetes criterion in this population.
- Subjects
HEMOGLOBINS; DIABETES risk factors; C-peptide; GLUCOSE tolerance tests; AMERICAN Diabetes Association
- Publication
Journal of Clinical Endocrinology & Metabolism, 2022, Vol 107, Issue 10, p2784
- ISSN
0021-972X
- Publication type
Article
- DOI
10.1210/clinem/dgac440