Use of the Diabetes Prevention Trial-Type 1 Risk Score (DPTRS) for Improving the Accuracy of the Risk Classification of Type 1 Diabetes

Author:

Sosenko Jay M.1,Skyler Jay S.1,Mahon Jeffrey2,Krischer Jeffrey P.3,Greenbaum Carla J.4,Rafkin Lisa E.1,Beam Craig A.3,Boulware David C.3,Matheson Della1,Cuthbertson David5,Herold Kevan C.6,Eisenbarth George7,Palmer Jerry P.8,

Affiliation:

1. Division of Endocrinology, University of Miami, Miami, FL

2. Department of Epidemiology and Biostatistics, University of Western Ontario, Ontario, Canada

3. Division of Informatics and Biostatistics, University of South Florida, Tampa, FL

4. Benaroya Research Institute at Virginia Mason, Seattle, WA

5. Pediatrics Epidemiology Center, University of South Florida, Tampa, FL

6. Department of Immunobiology, Yale University School of Medicine, New Haven, CT

7. Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, CO

8. VA Puget Sound Health Care System, Division of Endocrinology, Metabolism, and Nutrition, University of Washington, Seattle, WA

Abstract

OBJECTIVE We studied the utility of the Diabetes Prevention Trial-Type 1 Risk Score (DPTRS) for improving the accuracy of type 1 diabetes (T1D) risk classification in TrialNet Natural History Study (TNNHS) participants. RESEARCH DESIGN AND METHODS The cumulative incidence of T1D was compared between normoglycemic individuals with DPTRS values >7.00 and dysglycemic individuals in the TNNHS (n = 991). It was also compared between individuals with DPTRS values <7.00 or >7.00 among those with dysglycemia and those with multiple autoantibodies in the TNNHS. DPTRS values >7.00 were compared with dysglycemia for characterizing risk in Diabetes Prevention Trial-Type 1 (DPT-1) (n = 670) and TNNHS participants. The reliability of DPTRS values >7.00 was compared with dysglycemia in the TNNHS. RESULTS The cumulative incidence of T1D for normoglycemic TNNHS participants with DPTRS values >7.00 was comparable to those with dysglycemia. Among those with dysglycemia, the cumulative incidence was much higher (P < 0.001) for those with DPTRS values >7.00 than for those with values <7.00 (3-year risks: 0.16 for <7.00 and 0.46 for >7.00). Dysglycemic individuals in DPT-1 were at much higher risk for T1D than those with dysglycemia in the TNNHS (P < 0.001); there was no significant difference in risk between the studies among those with DPTRS values >7.00. The proportion in the TNNHS reverting from dysglycemia to normoglycemia at the next visit was higher than the proportion reverting from DPTRS values >7.00 to values <7.00 (36 vs. 23%). CONCLUSIONS DPTRS thresholds can improve T1D risk classification accuracy by identifying high-risk normoglycemic and low-risk dysglycemic individuals. The 7.00 DPTRS threshold characterizes risk more consistently between populations and has greater reliability than dysglycemia.

Publisher

American Diabetes Association

Subject

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

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