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Featured Article :. Prognostic Accuracy of Immunologic and Metabolic Markers for Type 1 Diabetes in a High-Risk Population: Receiver Operating Characteristic Analysis.

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Featured Article :

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  1. Featured Article: Prognostic Accuracy of Immunologic and Metabolic Markers for Type 1 Diabetes in a High-Risk Population: Receiver Operating Characteristic Analysis Ping Xu, M.P.H., Craig A. Beam, Ph.D., David Cuthbertson, M.S., Jay M. Sosenko, M.D., Jay S. Skyler, M.D., Jeffrey P. Krischer, Ph.D., The DPT-1 Study Group Diabetes Care Volume 35: 1975-1980 October, 2012

  2. STUDY OBJECTIVE • To establish and compare the prognostic accuracy of immunologic and metabolic markers in predicting onset of type 1 diabetes in high-risk individuals Xu P et al. Diabetes Care 2012;35:1975-1980

  3. STUDY DESIGN AND METHODS • 339 subjects from the Diabetes Prevention Trial–Type 1 (DPT-1) parenteral study followed until clinical diabetes onset or study end (5-year follow-up) • Subjects were islet cell antibody (ICA)-positive, with low first-phase insulin response (FPIR) and/or abnormal glucose tolerance at baseline • Prognostic performance of biomarkers estimated using receiver operating characteristic (ROC) curve analysis and compared with nonparametric testing of ROC curve areas • Pearson correlation used to assess the relationship between the markers Xu P et al. Diabetes Care 2012;35:1975-1980

  4. RESULTS • Insulin autoantibody titer, ICA512A titer, peak C-peptide, 2-h glucose, FPIR, and FPIR/homeostasis model assessment of insulin resistance provided modest but significant prognostic values for 5-year risk, with a similar level of area under ROC curve between 0.61 and 0.67 • Combining 2-h glucose, peak C-peptide, and area under the curve C-peptide improved the prognostic accuracy compared with any solitary index (P < 0.05), with an area under ROC curve of 0.76 (95% CI 0.70–0.81) • Adding antibody titers and/or intravenous glucose tolerance test (IVGTT) markers did not increase the prognostic accuracy further (P = 0.46 and P = 0.66, respectively) Xu P et al. Diabetes Care 2012;35:1975-1980

  5. Xu P et al. Diabetes Care 2012;35:1975-1980

  6. Xu P et al. Diabetes Care 2012;35:1975-1980

  7. Xu P et al. Diabetes Care 2012;35:1975-1980

  8. CONCLUSIONS • Combining metabolic markers derived from oral glucose tolerance test improved accuracy in predicting type 1 diabetes progression in a population with ICA positivity and abnormal metabolism • Autoimmune activity may not alter the risk of type 1 diabetes after metabolic function has deteriorated • Future consideration needed about eliminating IVGTT measurements as an effective cost-reduction strategy for prognostic purposes Xu P et al. Diabetes Care 2012;35:1975-1980

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