Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes

Benefits beyond glycemic control

H.R Murphy, Jonathan Roland, Timothy Skinner, David Simmons, Eleanor Gurnell, Nicholas Morrish, Shiu-Ching Soo, Suzannah Kelly, Boon Lim, Joanne Randall, Sarah Thompsett, Rosemary Temple

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: In this investigation we evaluated nine metabolic indexes from intravenous glucose tolerance tests (IVGTTs) and oral glucose tolerance tests (OGTTs) in an effort to determine their prognostic performance in predicting the development of type 1 diabetes in those with moderate risk, as defined by familial relation to a type 1 diabetic individual, a positive test for islet cell antibodies and insulin autoantibody, but normal glucose tolerance.

Research design and methods: Subjects (n = 186) who had a projected risk of 25–50% for developing type 1 diabetes within 5 years were followed until clinical diabetes onset or the end of the study as part of the Diabetes Prevention Trial–Type 1. Prognostic performance of the metabolic indexes was determined using receiver operating characteristic (ROC) curve and survival analyses.

Results: Two-hour glucose from an OGTT most accurately predicted progression to disease compared with all other metabolic indicators with an area under the ROC curve of 0.67 (95% CI 0.59–0.76), closely followed by the ratio of first-phase insulin response (FPIR) to homeostasis model assessment of insulin resistance (HOMA-IR) with an area under the curve value of 0.66. The optimal cutoff value for 2-h glucose (114 mg/dl) maintained sensitivity and specificity values >0.60. The hazard ratio for those with 2-h glucose ≥114 mg/dl compared with those with 2-h glucose <114 mg/dl was 2.96 (1.67–5.22).

Conclusions: The ratio of FPIR to HOMA-IR from an IVGTT provided accuracy in predicting the development of type 1 diabetes similar to that of 2-h glucose from an OGTT, which, because of its lower cost, is preferred. The optimal cutoff value determined for 2-h glucose provides additional guidance for clinicians to identify subjects for potential prevention treatments before the onset of impaired glucose tolerance.
Original languageEnglish
Pages (from-to)2514-2520
Number of pages7
JournalDiabetes Care
Volume33
Issue number12
DOIs
Publication statusPublished - Dec 2010
Externally publishedYes

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Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Glucose Tolerance Test
Glucose
Insulin
ROC Curve
Insulin Resistance
Homeostasis
Glucose Intolerance
Survival Analysis
Autoantibodies
Area Under Curve
Disease Progression
Research Design
Costs and Cost Analysis
Sensitivity and Specificity

Cite this

Murphy, H. R., Roland, J., Skinner, T., Simmons, D., Gurnell, E., Morrish, N., ... Temple, R. (2010). Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes: Benefits beyond glycemic control. Diabetes Care, 33(12), 2514-2520. https://doi.org/10.2337/dc10-1113
Murphy, H.R ; Roland, Jonathan ; Skinner, Timothy ; Simmons, David ; Gurnell, Eleanor ; Morrish, Nicholas ; Soo, Shiu-Ching ; Kelly, Suzannah ; Lim, Boon ; Randall, Joanne ; Thompsett, Sarah ; Temple, Rosemary. / Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes : Benefits beyond glycemic control. In: Diabetes Care. 2010 ; Vol. 33, No. 12. pp. 2514-2520.
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abstract = "Objective: In this investigation we evaluated nine metabolic indexes from intravenous glucose tolerance tests (IVGTTs) and oral glucose tolerance tests (OGTTs) in an effort to determine their prognostic performance in predicting the development of type 1 diabetes in those with moderate risk, as defined by familial relation to a type 1 diabetic individual, a positive test for islet cell antibodies and insulin autoantibody, but normal glucose tolerance.Research design and methods: Subjects (n = 186) who had a projected risk of 25–50{\%} for developing type 1 diabetes within 5 years were followed until clinical diabetes onset or the end of the study as part of the Diabetes Prevention Trial–Type 1. Prognostic performance of the metabolic indexes was determined using receiver operating characteristic (ROC) curve and survival analyses.Results: Two-hour glucose from an OGTT most accurately predicted progression to disease compared with all other metabolic indicators with an area under the ROC curve of 0.67 (95{\%} CI 0.59–0.76), closely followed by the ratio of first-phase insulin response (FPIR) to homeostasis model assessment of insulin resistance (HOMA-IR) with an area under the curve value of 0.66. The optimal cutoff value for 2-h glucose (114 mg/dl) maintained sensitivity and specificity values >0.60. The hazard ratio for those with 2-h glucose ≥114 mg/dl compared with those with 2-h glucose <114 mg/dl was 2.96 (1.67–5.22).Conclusions: The ratio of FPIR to HOMA-IR from an IVGTT provided accuracy in predicting the development of type 1 diabetes similar to that of 2-h glucose from an OGTT, which, because of its lower cost, is preferred. The optimal cutoff value determined for 2-h glucose provides additional guidance for clinicians to identify subjects for potential prevention treatments before the onset of impaired glucose tolerance.",
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Murphy, HR, Roland, J, Skinner, T, Simmons, D, Gurnell, E, Morrish, N, Soo, S-C, Kelly, S, Lim, B, Randall, J, Thompsett, S & Temple, R 2010, 'Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes: Benefits beyond glycemic control', Diabetes Care, vol. 33, no. 12, pp. 2514-2520. https://doi.org/10.2337/dc10-1113

Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes : Benefits beyond glycemic control. / Murphy, H.R; Roland, Jonathan; Skinner, Timothy; Simmons, David; Gurnell, Eleanor; Morrish, Nicholas; Soo, Shiu-Ching; Kelly, Suzannah; Lim, Boon; Randall, Joanne; Thompsett, Sarah; Temple, Rosemary.

In: Diabetes Care, Vol. 33, No. 12, 12.2010, p. 2514-2520.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes

T2 - Benefits beyond glycemic control

AU - Murphy, H.R

AU - Roland, Jonathan

AU - Skinner, Timothy

AU - Simmons, David

AU - Gurnell, Eleanor

AU - Morrish, Nicholas

AU - Soo, Shiu-Ching

AU - Kelly, Suzannah

AU - Lim, Boon

AU - Randall, Joanne

AU - Thompsett, Sarah

AU - Temple, Rosemary

PY - 2010/12

Y1 - 2010/12

N2 - Objective: In this investigation we evaluated nine metabolic indexes from intravenous glucose tolerance tests (IVGTTs) and oral glucose tolerance tests (OGTTs) in an effort to determine their prognostic performance in predicting the development of type 1 diabetes in those with moderate risk, as defined by familial relation to a type 1 diabetic individual, a positive test for islet cell antibodies and insulin autoantibody, but normal glucose tolerance.Research design and methods: Subjects (n = 186) who had a projected risk of 25–50% for developing type 1 diabetes within 5 years were followed until clinical diabetes onset or the end of the study as part of the Diabetes Prevention Trial–Type 1. Prognostic performance of the metabolic indexes was determined using receiver operating characteristic (ROC) curve and survival analyses.Results: Two-hour glucose from an OGTT most accurately predicted progression to disease compared with all other metabolic indicators with an area under the ROC curve of 0.67 (95% CI 0.59–0.76), closely followed by the ratio of first-phase insulin response (FPIR) to homeostasis model assessment of insulin resistance (HOMA-IR) with an area under the curve value of 0.66. The optimal cutoff value for 2-h glucose (114 mg/dl) maintained sensitivity and specificity values >0.60. The hazard ratio for those with 2-h glucose ≥114 mg/dl compared with those with 2-h glucose <114 mg/dl was 2.96 (1.67–5.22).Conclusions: The ratio of FPIR to HOMA-IR from an IVGTT provided accuracy in predicting the development of type 1 diabetes similar to that of 2-h glucose from an OGTT, which, because of its lower cost, is preferred. The optimal cutoff value determined for 2-h glucose provides additional guidance for clinicians to identify subjects for potential prevention treatments before the onset of impaired glucose tolerance.

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