Increasing the accuracy of oral glucose tolerance testing and extending its application to individuals with normal glucose tolerance for the prediction of type 1 diabetes: The diabetes prevention trial-type 1

Jay M. Sosenko, Jerry P. Palmer, Carla J. Greenbaum, Jeffrey Mahon, Catherine Cowie, Jeffrey P. Krischer, H. Peter Chase, Neil H. White, Bruce Buckingham, Kevan C. Herold, David Cuthbertson, Jay S. Skyler

Research output: Contribution to journalArticle

48 Scopus citations

Abstract

OBJECTIVE - We assessed the extent to which both standard and alternative indexes from 2-h oral glucose tolerance testing predict type 1 diabetes and whether oral glucose tolerance tests (OGTTs) predict type 1 diabetes in individuals with normal glucose tolerance. RESEARCH DESIGN AND METHODS - The prediction of type 1 diabetes from baseline OGTTs was studied in 704 Diabetes Prevention Trial-Type 1 participants (islet-cell autoantibody [ICA]-positive relatives of type 1 diabetic patients). The maximum follow-up was 7.4 years. Analyses utilized receiver-operator curves (ROCs), proportional hazards models, and survival curves. RESULTS - ROC areas under the curve (ROCAUCs) for both the AUC glucose (0.73 ± 0.02) and an OGTT prediction index (0.78 ± 0.02) were higher (P < 0.001) than those for the fasting (0.53 ± 0.02) and 2-h glucose (0.66 ± 0.02). ROCAUCs for the 60- and 90-min glucose (0.71 ± 0.02 and 0.72 ± 0.02, respectively) were also higher (P < 0.01) than those for the fasting and 2-h glucose. Among individuals with normal glucose tolerance, OGTTs were highly predictive, with 4th versus 1st quartile hazard ratios for the 2-h glucose, AUC glucose, and OGTT prediction index ranging from 3.77 to 5.30 (P < 0.001 for all). CONCLUSIONS - Certain alternative OGTT indexes appear to better predict type 1 diabetes than standard OGTT indexes in ICA-positive relatives of type 1 diabetic patients. Moreover, even among those with normal glucose tolerance, OGTTs are strongly predictive. This suggests that subtle metabolic abnormalities are present several years before the diagnosis of type 1 diabetes.

Original languageEnglish (US)
Pages (from-to)38-42
Number of pages5
JournalDiabetes care
Volume30
Issue number1
DOIs
StatePublished - Jan 1 2007

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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