In the Journals

Diabetes prevention scoring system improved accuracy of type 1 risk classification

Physicians can more accurately classify patients at risk for type 1 diabetes with the help of a scoring system that improves identification between high-risk normoglycemic and low-risk dysglycemic individuals, according to research published in Diabetes Care.

“The findings indicate that a reliance upon dysglycemia as a demarcation of risk in autoantibody-positive populations could result in a less-than-optimal classification of risk for prevention trials,” the researchers wrote.

Jay M. Sosenko, MD, of the University of Miami, and colleagues used the Diabetes Prevention Trial-Type Risk Score (DPTRS) to examine the cumulative incidence of type 1 diabetes in two cohorts — the Diabetes Prevention Trial-Type 1 (n=670) and TrialNet Natural History Study (n=991).

Participants in the Diabetes Prevention Trial-Type (DPT-1) were all positive for the islet cell autoantibody. Participants in the TrialNet Natural History Study (TNNHS) were all positive for multiple autoantibodies, possibly including islet cell. Both cohorts were given oral glucose tolerance tests at baseline and at 6-month intervals.

Incidence of type 1 diabetes was compared between individuals with normoglycemia with DPTRS values >7 and individuals with dysglycemia in the TNNHS. Incidence was also compared between individuals with DPTRS <7 or >7 among those with dysglycemia and those with multiple autoantibodies in the TNNHS. Researchers compared DPTRS values >7 with dysglycemia to characterize risk in both DPT-1 and the TNNHS participants. Then, the reliability of DPTRS values >7 was compared with dysglycemia in the TNNHS.

The cumulative incidence in TNNHS participants with normoglycemia and DPTRS values >7 was comparable to those with dysglycemia. Among those with dysglycemia, cumulative incidence was much higher for those with DPTRS values >7 than for those with values <7 (3-year risks: 0.16 for <7 and 0.46 for >7; P<.001). Individuals with dysglycemia in DPT-1 were at much higher risk than those with dysglycemia in the TNNHS (P<.001); there was no significant difference in risk between the studies among those with DPTRS values >7. The proportion of participants in the TNNHS reverting from dysglycemia to normoglycemia at the next visit was higher than the proportion reverting from DPTRS values >7 to values <7 (36% vs. 23%, respectively).

Disclosure: The work was funded through various institutes at the National Institutes of Health; the Juvenile Diabetes Research Foundation International, and the American Diabetes Association.