Incident dysglycemia and progression to type 1 diabetes among participants in the Diabetes Prevention Trial-Type 1
Open accessAbstract
OBJECTIVE: We studied the incidence of dysglycemia and its prediction of the development of type 1 diabetes in islet cell autoantibody (ICA)-positive individuals. In addition, we assessed whether dysglycemia was sustained. RESEARCH DESIGN AND METHODS: Participants (n = 515) in the Diabetes Prevention Trial-Type 1 (DPT-1) with normal glucose tolerance who underwent periodic oral glucose tolerance tests (OGTTs) were followed for incident dysglycemia (impaired fasting glucose, impaired glucose tolerance, and/or high glucose levels at intermediate time points of OGTTs). Incident dysglycemia at the 6-month visit was assessed for type 1 diabetes prediction. RESULTS: Of 515 participants with a normal baseline OGTT, 310 (60%) had at least one episode of dysglycemia over a maximum follow-up of 7 years. Dysglycemia at the 6-month visit was highly predictive of the development of type 1 diabetes, both in those aged <13 years (P < 0.001) and those aged > or =13 years (P < 0.01). Those aged <13 years with dysglycemia at the 6-month visit had a high cumulative incidence (94% estimate by 5 years). Among those who developed type 1 diabetes after a dysglycemic OGTT and who had at least two OGTTs after the dysglycemic OGTT, 33 of 64 (52%) reverted back to a normal OGTT. However, 26 (79%) of the 33 then had another dysglycemic OGTT before diagnosis. CONCLUSIONS: ICA-positive individuals with normal glucose tolerance had a high incidence of dysglycemia. Incident dysglycemia in those who are ICA positive is strongly predictive of type 1 diabetes. Children with incident dysglycemia have an especially high risk. Fluctuations in and out of the dysglycemic state are not uncommon before the onset of type 1 diabetes.
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At stage 2 of type 1 diabetes, there is ~60% risk by 2 years and ~75% risk within 5 years of developing symptomatic type 1 diabetes.
“At stage 2 of the disease, there is 60% risk by 2 years and 75% risk within 5 years of developing symptomatic type 1 diabetes (57,58).”
From 2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [57]
The Results (page not provided) show that dysglycemia predicted progression to type 1 diabetes, supporting the claim’s general point. They do not report a 60% risk of symptomatic diabetes by two years or a 75% risk by five years for people at stage 2: the reported progression estimates are 65% at four years after dysglycemia and 94% at five years for dysglycemic children under 13. The paper’s roughly 41% and 73% two- and five-year estimates concern developing dysglycemia, not symptomatic diabetes. (LLM, conf=0.87)
Experimental — accuracy not yet measuredAt stage 2 of type 1 diabetes, there is 60% risk by 2 years and 75% risk within 5 years of developing a clinical diagnosis of type 1 diabetes.
“At stage 2 of the disease, there is 60% risk by 2 years and 75% risk within 5 years of developing a clinical diagnosis of type 1 diabetes (55,56).”
From 2. Diagnosis and classification of diabetes: standards of care in diabetes-2025 (2025) · cites this paper as [55]
The Results report that dysglycemia predicted progression to clinical type 1 diabetes, and that 75% of a small subgroup of children under 13 with persistent dysglycemia developed it during a maximum follow-up of 4.5 years. They do not report a 60% risk by two years or a 75% five-year risk for everyone at stage 2; the reported five-year estimate for children under 13 with dysglycemia was 94%. Page numbers were not available in our copy. (LLM, conf=0.86)
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References 18 · Cited by 76
- Authors
- Sosenko, J. M., Palmer, J. P., Rafkin-Mervis, L., Krischer, J. P., Cuthbertson, D., Mahon, J., Greenbaum, C. J., Cowie, C. C., Skyler, J. S., & the Diabetes Prevention Trial–Type 1 Study Group
- Affiliations
- University of Miami (US)
- University of Washington (US)
- Division of Endocrinology, University of Miami, Miami, Florida;
- University of South Florida (US)
- Western University (CA)
- Benaroya Research Institute (US)
- National Institutes of Health (US)
- Corresponding author
- Sosenko, Jay M.
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2009-06-01
- Volume
- 32
- Issue
- 9
- Pages
- 1603-1607
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC2732147
- OpenAlex
- W2124855406
- Cited by
- 76
- References
- 18
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 11 · 2023: 5 · 2022: 6 · 2021: 5 · 2020: 1 · 2019: 3 · 2018: 2 · 2017: 4 · 2016: 9 · 2015: 6 · 2014: 4 · 2013: 3 · 2012: 1
- FWCI
- 2.34
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (UC4DK117009)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Keywords
- type 1 diabetes, dysglycemia, islet autoantibodies, impaired glucose tolerance, impaired fasting glucose, oral glucose tolerance test, prediabetes, disease progression, children, risk prediction
- MeSH terms
- Adolescent, Blood Glucose, Child, Diabetes Mellitus, Type 1, Female, Glucose Tolerance Test, Humans, Male, Proportional Hazards Models, Glucose Intolerance
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