title: The application of the diabetes prevention trial-type 1 risk score for identifying a preclinical state of type 1 diabetes.
abstract: OBJECTIVE
  We assessed the utility of the Diabetes Prevention Trial-Type 1 Risk Score (DPTRS) for identifying individuals who are highly likely to progress to type 1 diabetes (T1D) within 2 years.
  
  
  METHODS
  The DPTRS was previously developed from Diabetes Prevention Trial-Type 1 (DPT-1) data and was subsequently validated in the TrialNet Natural History Study (TNNHS). DPTRS components included C-peptide and glucose indexes from oral glucose tolerance testing, along with age and BMI. The cumulative incidence of T1D was determined after DPTRS thresholds were first exceeded and after the first occurrences of glucose abnormalities.
  
  
  RESULTS
  The 2-year risks after the 9.00 DPTRS threshold was exceeded were 0.88 and 0.77 in DPT-1 (n = 90) and the TNNHS (n = 69), respectively. In DPT-1, the 2-year risks were much lower after dysglycemia first occurred (0.37; n = 306) and after a 2-h glucose value between 190 and 199 mg/dL was first reached (0.64; n = 59). Among those who developed T1D in DPT-1, the 9.00 threshold was exceeded 0.81 ± 0.53 years prior to the conventional diagnosis. Postchallenge C-peptide levels were substantially higher (P = 0.001 for 30 min; P < 0.001 for other time points) when the 9.00 threshold was first exceeded compared with the levels at diagnosis.
  
  
  CONCLUSIONS
  A DPTRS threshold of 9.00 identifies individuals who are very highly likely to progress to the conventional diagnosis of T1D within 2 years and, thus, are essentially in a preclinical diabetic state. The 9.00 threshold is exceeded well before diagnosis, when stimulated C-peptide levels are substantially higher.
authors.affiliation: Division of Endocrinology, University of Miami, Miami, FL, USA. jsosenko@med.miami.edu
authors.forename: Jay M
authors.initials: JM
authors.lastname: Sosenko
authors.forename: Jay S
authors.initials: JS
authors.lastname: Skyler
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Mahon
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Krischer
authors.forename: Craig A
authors.initials: CA
authors.lastname: Beam
authors.forename: David C
authors.initials: DC
authors.lastname: Boulware
authors.forename: Carla J
authors.initials: CJ
authors.lastname: Greenbaum
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Rafkin
authors.forename: Catherine
authors.initials: C
authors.lastname: Cowie
authors.forename: David
authors.initials: D
authors.lastname: Cuthbertson
authors.forename: Jerry P
authors.initials: JP
authors.lastname: Palmer
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D005951:Glucose Tolerance Test; D006801:Humans; D015994:Incidence; D011236:Prediabetic State / Q000175:diagnosis* / Q000453:epidemiology; D012306:Risk
chemical_list: D001786:Blood Glucose; D002096:C-Peptide