Introduction and Objective: Evidence suggests an IP occurs 1 to 2 years before the diagnosis of T1D, after which accelerated metabolic decline occurs. We assessed whether IPs vary when stratified by age, obesity, sex, and presence of both HLA DR3 and DR4 vs. neither.
Methods: TrialNet Pathway to Prevention Ab+ participants (n=596) who had OGTTs between 0.5 years and 3 years before diagnosis were studied. Mixed-effects modeling was used to estimate AUC glucose and AUC C-peptide IPs with 95% confidence intervals (CIs), and to compare IP times before diagnosis. Since AUC C-peptide IPs had wide CIs, only AUC glucose IPs are shown.
Results: The overall AUC glucose IP was 1.39 years before diagnosis. Those older or obese had IPs significantly earlier; however, the difference by age groups was only ~0.2 years and that by obesity 0.1 year (table). The difference between those positive for both DR3 and DR4 was small while males and females did not differ. IPs were consistently within 1.3 and 1.5 years before diagnosis.
Conclusion: Older and more obese individuals have earlier AUC glucose IPs prior to diagnosis. However, the timing of the IPs differs only by a few months between populations that have demographic or genetic differences. This suggests common pathologic progression patterns to T1D despite variations in characteristics.
H.M. Ismail: Consultant; Sanofi, Rise Therapeutics. D.D. Cuthbertson: None. L.M. Jacobsen: Advisory Panel; Insulet Corporation. B.M. Nathan: None. E.K. Sims: Consultant; Sanofi. Board Member; American Diabetes Association. Other Relationship; American Diabetes Association, Medscape. Consultant; DRI. M.J. Redondo: None. J. Sosenko: None.
National Institute of Diabetes and Digestive and Kidney Diseases
