Dysglycemia and Index60 as prediagnostic end points for type 1 diabetes prevention trials

Abstract

OBJECTIVE We assessed dysglycemia and a T1D Diagnostic Index60 (Index60) ≥1.00 (on the basis of fasting C-peptide, 60-min glucose, and 60-min C-peptide levels) as prediagnostic end points for type 1 diabetes among Type 1 Diabetes TrialNet Pathway to Prevention Study participants. RESEARCH DESIGN AND METHODS Two cohorts were analyzed: 1) baseline normoglycemic oral glucose tolerance tests (OGTTs) with an incident dysglycemic OGTT and 2) baseline Index60 <1.00 OGTTs with an incident Index60 ≥1.00 OGTT. Incident dysglycemic OGTTs were divided into those with (DYS/IND+) and without (DYS/IND2) concomitant Index60 ≥1.00. Incident Index60 ≥1.00 OGTTs were divided into those with (IND/DYS+) and without (IND/DYS2) concomitant dysglycemia. RESULTS The cumulative incidence for type 1 diabeteswas greater after IND/DYS2than after DYS/IND2(P < 0.01).Within the normoglycemic cohort, the cumulative incidence of type 1 diabeteswas higher afterDYS/IND+ than afterDYS/IND2(P < 0.001),whereas within the Index60 <1.00 cohort, the cumulative incidence after IND/DYS+ and after IND/DYS2 did not differ significantly. Among nonprogressors, type 1 diabetes risk at the last OGTT was greater for IND/DYS2 than for DYS/IND2 (P < 0.001). Hazard ratios (HRs) ofDYS/IND2with age and 30- to 0-min C-peptidewere positive (P < 0.001 for both), whereas HRs of type 1 diabetes with these variables were inverse (P < 0.001 for both). In contrast, HRs of IND/DYS2 and type 1 diabetes with age and 30- to 0-min C-peptide were consistent (all inverse [P < 0.01 for all]). CONCLUSIONS The findings suggest that incident dysglycemia without Index60 ≥1.00 is a suboptimal prediagnostic end point for type 1 diabetes. Measures that include both glucose and C-peptide levels, suchas Index60≥1.00, appear better suited as prediagnostic end points.