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Wilson DM, Pietropaolo SL, Acevedo-Calado M, Huang S, Anyaiwe D, Scheinker D, Steck AK, Vasudevan MM, McKay SV, Sherr JL, Herold KC, Dunne JL, Greenbaum CJ, Lord SM, Haller MJ, Schatz DA, Atkinson MA, Nelson PW, Pietropaolo M. CGM Metrics Identify Dysglycemic States in Participants From the TrialNet Pathway to Prevention Study. Diabetes Care 2023; 46:526-534. [PMID: 36730530 PMCID: PMC10020029 DOI: 10.2337/dc22-1297] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/28/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Continuous glucose monitoring (CGM) parameters may identify individuals at risk for progression to overt type 1 diabetes. We aimed to determine whether CGM metrics provide additional insights into progression to clinical stage 3 type 1 diabetes. RESEARCH DESIGN AND METHODS One hundred five relatives of individuals in type 1 diabetes probands (median age 16.8 years; 89% non-Hispanic White; 43.8% female) from the TrialNet Pathway to Prevention study underwent 7-day CGM assessments and oral glucose tolerance tests (OGTTs) at 6-month intervals. The baseline data are reported here. Three groups were evaluated: individuals with 1) stage 2 type 1 diabetes (n = 42) with two or more diabetes-related autoantibodies and abnormal OGTT; 2) stage 1 type 1 diabetes (n = 53) with two or more diabetes-related autoantibodies and normal OGTT; and 3) negative test for all diabetes-related autoantibodies and normal OGTT (n = 10). RESULTS Multiple CGM metrics were associated with progression to stage 3 type 1 diabetes. Specifically, spending ≥5% time with glucose levels ≥140 mg/dL (P = 0.01), ≥8% time with glucose levels ≥140 mg/dL (P = 0.02), ≥5% time with glucose levels ≥160 mg/dL (P = 0.0001), and ≥8% time with glucose levels ≥160 mg/dL (P = 0.02) were all associated with progression to stage 3 disease. Stage 2 participants and those who progressed to stage 3 also exhibited higher mean daytime glucose values; spent more time with glucose values over 120, 140, and 160 mg/dL; and had greater variability. CONCLUSIONS CGM could aid in the identification of individuals, including those with a normal OGTT, who are likely to rapidly progress to stage 3 type 1 diabetes.
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Affiliation(s)
- Darrell M. Wilson
- Division of Pediatric Endocrinology, Stanford University School of Medicine, Palo Alto, CA
| | - Susan L. Pietropaolo
- Division of Endocrinology, Diabetes, and Metabolism, Diabetes Research Center, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Maria Acevedo-Calado
- Division of Endocrinology, Diabetes, and Metabolism, Diabetes Research Center, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Shuai Huang
- Department of Industrial & Systems Engineering, University of Washington, Seattle, WA
| | - Destiny Anyaiwe
- Department of Mathematics & Computer Science, Lawrence Technological University, Southfield, MI
| | - David Scheinker
- Division of Pediatric Endocrinology, Stanford University School of Medicine, Palo Alto, CA
| | - Andrea K. Steck
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Madhuri M. Vasudevan
- Division of Endocrinology, Diabetes, and Metabolism, Diabetes Research Center, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Siripoom V. McKay
- Division of Endocrinology, Diabetes, and Metabolism, Diabetes Research Center, Department of Medicine, Baylor College of Medicine, Houston, TX
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Jennifer L. Sherr
- Division of Pediatric Endocrinology, Yale University School of Medicine, New Haven, CT
| | - Kevan C. Herold
- Departments of Immunobiology and Internal Medicine, Yale University, New Haven, CT
| | | | - Carla J. Greenbaum
- Center for Interventional Immunology and Diabetes Program, Benaroya Research Institute, Seattle, WA
| | - Sandra M. Lord
- Center for Interventional Immunology and Diabetes Program, Benaroya Research Institute, Seattle, WA
| | - Michael J. Haller
- Department of Pediatrics, University of Florida Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL
| | - Desmond A. Schatz
- Department of Pediatrics, University of Florida Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL
| | - Mark A. Atkinson
- Department of Pediatrics, University of Florida Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL
| | - Patrick W. Nelson
- Department of Mathematics & Computer Science, Lawrence Technological University, Southfield, MI
| | - Massimo Pietropaolo
- Division of Endocrinology, Diabetes, and Metabolism, Diabetes Research Center, Department of Medicine, Baylor College of Medicine, Houston, TX
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Ferrara CT, Geyer SM, Evans-Molina C, Libman IM, Becker DJ, Wentworth JM, Moran A, Gitelman SE, Redondo MJ. The Role of Age and Excess Body Mass Index in Progression to Type 1 Diabetes in At-Risk Adults. J Clin Endocrinol Metab 2017; 102:4596-4603. [PMID: 29092051 PMCID: PMC5718698 DOI: 10.1210/jc.2017-01490] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/03/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Given the global rise in both type 1 diabetes incidence and obesity, the role of body mass index (BMI) on type 1 diabetes pathophysiology has gained great interest. Sustained excess BMI in pediatric participants of the TrialNet Pathway to Prevention (PTP) cohort increased risk for progression to type 1 diabetes, but the effects of age and obesity in adults remain largely unknown. OBJECTIVE To determine the effect of age and sustained obesity on the risk for type 1 diabetes in adult participants in the TrialNet PTP cohort (i.e., nondiabetic autoantibody-positive relatives of patients with type 1 diabetes). RESEARCH DESIGN AND METHODS Longitudinally accumulated BMI >25 kg/m2 was calculated to generate a cumulative excess BMI (ceBMI) for each participant, with ceBMI values ≥0 kg/m2 and ≥5 kg/m2 representing sustained overweight or obese status, respectively. Recursive partitioning analysis yielded sex- and age-specific thresholds for ceBMI that confer the greatest risk for type 1 diabetes progression. RESULTS In this cohort of 665 adults (age 20 to 50 years; median follow-up, 3.9 years), 49 participants developed type 1 diabetes. Age was an independent protective factor for type 1 diabetes progression (hazard ratio, 0.95; P = 0.008), with a threshold of >35 years that reduced risk for type 1 diabetes. In men age >35 years and women age <35 years, sustained obesity (ceBMI ≥5 kg/m2) increased the risk for type 1 diabetes. CONCLUSIONS Age is an important factor for type 1 diabetes progression in adults and influences the impact of elevated BMI, indicating an interplay of excess weight, age, and sex in adult type 1 diabetes pathophysiology.
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Affiliation(s)
- Christine T. Ferrara
- Department of Pediatric Endocrinology, University of California at San Francisco, San Francisco, California 94143
| | - Susan M. Geyer
- Department of Informatics and Biostatistics, University of Southern Florida, Tampa, Florida 33620
| | - Carmella Evans-Molina
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202
| | - Ingrid M. Libman
- Department of Pediatric Endocrinology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania 15224
| | - Dorothy J. Becker
- Department of Pediatric Endocrinology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania 15224
| | - John M. Wentworth
- Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - Antoinette Moran
- Department of Pediatric Endocrinology, University of Minnesota, Minneapolis, Minnesota 55455
| | - Stephen E. Gitelman
- Department of Pediatric Endocrinology, University of California at San Francisco, San Francisco, California 94143
| | - Maria J. Redondo
- Section of Pediatric Endocrinology, Texas Children’s Hospital, Houston, Texas 77030
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Steck AK, Xu P, Geyer S, Redondo MJ, Antinozzi P, Wentworth JM, Sosenko J, Onengut-Gumuscu S, Chen WM, Rich SS, Pugliese A. Can Non-HLA Single Nucleotide Polymorphisms Help Stratify Risk in TrialNet Relatives at Risk for Type 1 Diabetes? J Clin Endocrinol Metab 2017; 102:2873-2880. [PMID: 28520980 PMCID: PMC5546868 DOI: 10.1210/jc.2016-4003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/11/2017] [Indexed: 01/10/2023]
Abstract
CONTEXT Genome-wide association studies identified >50 type 1 diabetes (T1D) associated non-human leukocyte antigens (non-HLA) loci. OBJECTIVE The purpose of this study was to assess the contribution of non-HLA single nucleotide polymorphisms (SNPs) to risk of disease progression. DESIGN AND SETTING The TrialNet Pathway to Prevention Study follows relatives of T1D patients for development of autoantibodies (Abs) and T1D. PARTICIPANTS Using the Immunochip, we analyzed 53 diabetes-associated, non-HLA SNPs in 1016 Ab-positive, at-risk non-Hispanic white relatives. MAIN OUTCOME MEASURE Effect of SNPs on the development of multiple Abs and T1D. RESULTS Cox proportional analyses included all substantial non-HLA SNPs, HLA genotypes, relationship to proband, sex, age at initial screening, initial Ab type, and number. Factors involved in progression from single to multiple Abs included age at screening, relationship to proband, HLA genotypes, and rs3087243 (cytotoxic T lymphocyte antigen-4). Significant factors for diabetes progression included age at screening, Ab number, HLA genotypes, rs6476839 [GLIS family zinc finger 3 (GLIS3)], and rs3184504 [SH2B adaptor protein 3 (SH2B3)]. When glucose area under the curve (AUC) was included, factors involved in disease progression included glucose AUC, age at screening, Ab number, relationship to proband, HLA genotypes, rs6476839 (GLIS3), and rs7221109 (CCR7). In stratified analyses by age, glucose AUC, age at screening, sibling, HLA genotypes, rs6476839 (GLIS3), and rs4900384 (C14orf64) were significantly associated with progression to diabetes in participants <12 years old, whereas glucose AUC, sibling, rs3184504 (SH2B3), and rs4900384 (C14orf64) were significant in those ≥12. CONCLUSIONS In conclusion, we identified five non-HLA SNPs associated with increased risk of progression from Ab positivity to disease that may improve risk stratification for prevention trials.
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Affiliation(s)
- Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045
| | - Ping Xu
- Health Informatics Institute, University of South Florida, Tampa, Florida 33612
| | - Susan Geyer
- Health Informatics Institute, University of South Florida, Tampa, Florida 33612
| | - Maria J. Redondo
- Pediatric Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas 77030
| | - Peter Antinozzi
- Center for Diabetes Research, Wake Forest School of Medicine, Winston Salem, North Carolina 27157
| | - John M. Wentworth
- Division of Population Health and Immunity, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia
- Royal Melbourne Hospital Department of Medicine, University of Melbourne, Parkville, Victoria 3050, Australia
| | - Jay Sosenko
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Miami School of Medicine, Miami, Florida 33136
| | - Suna Onengut-Gumuscu
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia 22903
| | - Wei-Min Chen
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia 22903
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia 22903
| | - Alberto Pugliese
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Miami School of Medicine, Miami, Florida 33136
- Diabetes Research Institute and Department of Microbiology and Immunology, University of Miami School of Medicine, Miami, Florida 33136
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