title: Prognostic performance of metabolic indexes in predicting onset of type 1 diabetes.
abstract: OBJECTIVE
  In this investigation we evaluated nine metabolic indexes from intravenous glucose tolerance tests (IVGTTs) and oral glucose tolerance tests (OGTTs) in an effort to determine their prognostic performance in predicting the development of type 1 diabetes in those with moderate risk, as defined by familial relation to a type 1 diabetic individual, a positive test for islet cell antibodies and insulin autoantibody, but normal glucose tolerance.
  
  
  METHODS
  Subjects (n = 186) who had a projected risk of 25-50% for developing type 1 diabetes within 5 years were followed until clinical diabetes onset or the end of the study as part of the Diabetes Prevention Trial-Type 1. Prognostic performance of the metabolic indexes was determined using receiver operating characteristic (ROC) curve and survival analyses.
  
  
  RESULTS
  Two-hour glucose from an OGTT most accurately predicted progression to disease compared with all other metabolic indicators with an area under the ROC curve of 0.67 (95% CI 0.59-0.76), closely followed by the ratio of first-phase insulin response (FPIR) to homeostasis model assessment of insulin resistance (HOMA-IR) with an area under the curve value of 0.66. The optimal cutoff value for 2-h glucose (114 mg/dl) maintained sensitivity and specificity values >0.60. The hazard ratio for those with 2-h glucose ≥ 114 mg/dl compared with those with 2-h glucose <114 mg/dl was 2.96 (1.67-5.22).
  
  
  CONCLUSIONS
  The ratio of FPIR to HOMA-IR from an IVGTT provided accuracy in predicting the development of type 1 diabetes similar to that of 2-h glucose from an OGTT, which, because of its lower cost, is preferred. The optimal cutoff value determined for 2-h glucose provides additional guidance for clinicians to identify subjects for potential prevention treatments before the onset of impaired glucose tolerance.
authors.affiliation: Department of Pediatrics, College of Medicine, University of South Florida, Tampa, Florida, USA. xup@epi.usf.edu
authors.forename: Ping
authors.initials: P
authors.lastname: Xu
authors.forename: Yougui
authors.initials: Y
authors.lastname: Wu
authors.forename: Yiliang
authors.initials: Y
authors.lastname: Zhu
authors.forename: Getachew
authors.initials: G
authors.lastname: Dagne
authors.forename: Giffe
authors.initials: G
authors.lastname: Johnson
authors.forename: David
authors.initials: D
authors.lastname: Cuthbertson
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Krischer
authors.forename: Jay M
authors.initials: JM
authors.lastname: Sosenko
authors.forename: Jay S
authors.initials: JS
authors.lastname: Skyler
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism* / Q000473:pathology; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008137:Longitudinal Studies; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results
chemical_list: D001786:Blood Glucose
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