Index60 可识别出 2 小时血糖水平正常的自身抗体阳性人群中处于 3 期风险的个体：对当前 1 型糖尿病分期标准的影响。
Index60 Identifies Individuals at Appreciable Risk for Stage 3 Among an Autoantibody-Positive Population With Normal 2-Hour Glucose Levels: Implications for Current Staging Criteria of Type 1 Diabetes.
机构信息
University of Minnesota, Minneapolis, MN.
Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
出版信息
Diabetes Care. 2022 Feb 1;45(2):311-318. doi: 10.2337/dc21-0944.
OBJECTIVE
We assessed whether Index60, a composite measure of fasting C-peptide, 60-min C-peptide, and 60-min glucose, could improve the metabolic staging of type 1 diabetes for progression to clinical disease (stage 3) among autoantibody-positive (Ab+) individuals with normal 2-h glucose values (<140 mg/dL).
RESEARCH DESIGN AND METHODS
We analyzed 3,058 Type 1 Diabetes TrialNet Pathway to Prevention participants with 2-h glucose <140 mg/dL and Index60 <1.00 values from baseline oral glucose tolerance tests. Characteristics associated with type 1 diabetes (younger age, greater Ab+, higher HLA DR3-DQ2/DR4-DQ8 prevalence, and lower C-peptide) were compared among four mutually exclusive groups: top 2-h glucose quartile only (HI-2HGLU), top Index60 quartile only (HI-IND60), both top quartiles (HI-BOTH), and neither top quartile (LO-BOTH). Additionally, within the 2-h glucose distribution of <140 mg/dL and separately within the Index60 <1.00 distribution, comparisons were made between those above or below the medians.
RESULTS
HI-IND60 and HI-BOTH were younger, with greater frequency of more than two Ab+, and lower C-peptide levels, than either HI-2HGLU or LO-BOTH (all P < 0.001). The cumulative incidence for stage 3 was greater for HI-IND60 and HI-BOTH than for either HI-2HGLU or LO-BOTH (all P < 0.001). Those with Index60 values above the median were younger and had higher frequency of two or more Ab+ (P < 0.001) and DR3-DQ2/DR4-DQ8 prevalence (P < 0.001) and lower area under the curve (AUC) C-peptide levels (P < 0.001) than those below. Those above the 2-h glucose median had higher AUC C-peptide levels (P < 0.001), but otherwise did not differ from those below.
CONCLUSIONS
Index60 identifies individuals with characteristics of type 1 diabetes at appreciable risk for progression who would otherwise be missed by 2-h glucose staging criteria.
目的
我们评估 Index60（空腹 C 肽、60 分钟 C 肽和 60 分钟血糖的综合指标）是否可以改善 1 型糖尿病的代谢分期，以预测自身抗体阳性（Ab+）且 2 小时血糖值正常（<140mg/dL）的个体向临床疾病（第 3 期）的进展。
研究设计和方法
我们分析了来自 1 型糖尿病试验网预防途径的 3058 名参与者，他们在基线口服葡萄糖耐量试验中有 2 小时血糖值<140mg/dL 和 Index60 值<1.00。在四个相互排斥的组中比较了与 1 型糖尿病相关的特征（年龄较小、Ab+更多、HLA DR3-DQ2/DR4-DQ8 患病率更高、C 肽水平更低）：仅 2 小时血糖最高四分位数（HI-2HGLU）、仅 Index60 最高四分位数（HI-IND60）、两者均为最高四分位数（HI-BOTH）和两者均不在最高四分位数（LO-BOTH）。此外，在<140mg/dL 的 2 小时血糖分布内，并分别在 Index60<1.00 的分布内，比较了高于或低于中位数的个体。
结果
HI-IND60 和 HI-BOTH 比 HI-2HGLU 或 LO-BOTH 更年轻，Ab+的频率更高，且 C 肽水平更低（均 P<0.001）。HI-IND60 和 HI-BOTH 的第 3 期累积发生率大于 HI-2HGLU 或 LO-BOTH（均 P<0.001）。Index60 值高于中位数的个体更年轻，Ab+的频率更高（P<0.001），且 DR3-DQ2/DR4-DQ8 患病率（P<0.001）和 AUC C 肽水平（P<0.001）更低。那些 2 小时血糖值高于中位数的个体的 AUC C 肽水平更高（P<0.001），但其他方面与低于中位数的个体没有差异。
结论
Index60 可识别出具有 1 型糖尿病特征的个体，他们处于明显的进展风险中，否则将被 2 小时血糖分期标准所遗漏。
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