Clinical Prediction Models Combining Routine Clinical Measures Have High Accuracy in Identifying Youth-Onset Type 2 Diabetes Defined by Maintained Endogenous Insulin Secretion: The SEARCH for Diabetes in Youth Study.

Autor:	Jones AG; University of Exeter Medical School, Exeter, U.K., Shields BM; University of Exeter Medical School, Exeter, U.K., Oram RA; University of Exeter Medical School, Exeter, U.K., Dabelea DM; University of Colorado Anschutz Medical Campus, Aurora, CO., Hagopian WA; University of Washington, Seattle, WA., Sharp SA; Department of Genetics, Stanford University School of Medicine, Stanford, CA., Lustigova E; Kaiser Permanente Southern California, Los Angeles, CA., Shah AS; University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, OH., Knupp J; University of Exeter Medical School, Exeter, U.K., Mottl AK; University of North Carolina at Chapel Hill, Chapel Hill, NC., D'Agostino RB Jr; Wake Forest School of Medicine, Winston-Salem, NC., Williams A; Wake Forest School of Medicine, Winston-Salem, NC., Marcovina SM; Medpace Reference Laboratories, Cincinnati, OH., Pihoker C; University of Washington, Seattle, WA., Divers J; Wake Forest School of Medicine, Winston-Salem, NC., Redondo MJ; Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
Jazyk:	angličtina
Zdroj:	Diabetes care [Diabetes Care] 2024 Dec 01; Vol. 47 (12), pp. 2110-2119.
DOI:	10.2337/dc23-1815
Abstrakt:	Objective: With high prevalence of obesity and overlapping features between diabetes subtypes, accurately classifying youth-onset diabetes can be challenging. We aimed to develop prediction models that, using characteristics available at diabetes diagnosis, can identify youth who will retain endogenous insulin secretion at levels consistent with type 2 diabetes (T2D). Research Design and Methods: We studied 2,966 youth with diabetes in the prospective SEARCH for Diabetes in Youth study (diagnosis age ≤19 years) to develop prediction models to identify participants with fasting C-peptide ≥250 pmol/L (≥0.75 ng/mL) after >3 years' (median 74 months) diabetes duration. Models included clinical measures at the baseline visit, at a mean diabetes duration of 11 months (age, BMI, sex, waist circumference, HDL cholesterol), with and without islet autoantibodies (GADA, IA-2A) and a type 1 diabetes genetic risk score (T1DGRS). Results: Models using routine clinical measures with or without autoantibodies and T1DGRS were highly accurate in identifying participants with C-peptide ≥0.75 ng/mL (17% of participants; 2.3% and 53% of those with and without positive autoantibodies) (area under the receiver operating characteristic curve [AUCROC] 0.95-0.98). In internal validation, optimism was very low, with excellent calibration (slope 0.995-0.999). Models retained high performance for predicting retained C-peptide in older youth with obesity (AUCROC 0.88-0.96) and in subgroups defined by self-reported race and ethnicity (AUCROC 0.88-0.97), autoantibody status (AUCROC 0.87-0.96), and clinically diagnosed diabetes types (AUCROC 0.81-0.92). Conclusions: Prediction models combining routine clinical measures at diabetes diagnosis, with or without islet autoantibodies or T1DGRS, can accurately identify youth with diabetes who maintain endogenous insulin secretion in the range associated with T2D. (© 2024 by the American Diabetes Association.)
Databáze:	MEDLINE
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