Pre-type 1 diabetes dysmetabolism: Maximal sensitivity achieved with both oral and intravenous glucose tolerance testing

Barker, JM; Harrison, LC; Fourlanos, S; Krischer, J; Cuthbertson, D; Chase, HP; Eisenbarth, GS

Author(s): Barker, JM; Harrison, LC; Fourlanos, S; Krischer, J; Cuthbertson, D; Chase, HP; Eisenbarth, GS;
Details: Publication Year 2007-01,Volume 150,Issue #1,Page 31-36
Journal Title: JOURNAL OF PEDIATRICS
Publication Type: Journal Article
Abstract: Objective. To determine the relationship of intravenous (IVGTT) and oral (OGTT) glucose tolerance tests abnormalities to diabetes development in a high-risk pre-diabetic cohort and to identify an optimal testing strategy for detecting preclinical diabetes. Study design. Diabetes Prevention Ttial-Type 1 Diabetes (DPT-1) randomized subjects to oral (n = 372) and parenteral (n = 339) insulin prevention trials. Subjects were followed with IVGTTs and OGTTs. Factors associated with progression to diabetes were evaluated. Results. Survival analysis revealed that higher quartiles of 2-hour glucose and lower quartiles of first phase insulin response (FPIR) at baseline were associated with decreased diabetes-free survival. Cox proportional hazards modeling showed that baseline body mass index (BMI), FPIR, and 2-hour glucose levels were significantly associated with an increased hazard for diabetes. On testing performed within 6 months of diabetes diagnosis, 3% (1/32) had normal FPIR and normal 2-hour glucose on OGTT. The sensitivities for impaired glucose tolerance (IGT) and low FPIR performed within 6 months of diabetes diagnosis were equivalent (76% vs 73%). Conclusions. Most (97%) subjects had abnormal IVGTTs and/or OGTTs before the development of diabetes. The highest sensitivity is achieved using both tests.
Publisher: MOSBY-ELSEVIER
Keywords: ANTIBODY-POSITIVE RELATIVES; ISLET-CELL ANTIBODIES; ACCELERATOR HYPOTHESIS; INSULIN-RESISTANCE; RISK-FACTOR; AUTOANTIBODIES; PREDICTION; MELLITUS; IDDM; PROGRESSION
Publisher's Version: https://doi.org/10.1016/j.jpeds.2006.09.033
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2007-01-01 12:00:00