风险模型可早期预测1型糖尿病

研究人员在此报道称，来自一项1型糖尿病大规模流行病学研究风险预测数据基础上的一个阈值或许有助于更好地预测哪些病人将会进展为疾病（糖尿病）。

迈阿密大学的JaySosenko及其同事们在美国糖尿病协会会议（ADA）上称，依照Index60算法，超过特定阈值的患者当中总共有90%最终被诊断为1型糖尿病。

在一个发布会上，Sosenko说：“如果我们能较早地诊断患者，他们将有更多的胰岛素可供利用，而我们也能在疾病的较早期阶段对他们进行治疗。”

Index60是一个以空腹C肽、60分钟葡萄糖，以及在1型糖尿病预测试验（DPT-1）中口服糖耐量试验（OGTTs）60分钟C肽基线为基础的比例风险模型。

Sosenko表示，Index60是之前由试验进展而来的风险预测分数的一个进步。首先一点是基于五大特色：年龄、体重指数（BMI）、空腹C肽、30-120分钟C肽总和，以及30-120分钟的血糖水平总和。

在DPT-1中，该模型可高度预测1型糖尿病的进展，并在随后一项来自TrialNet（另外一个大的糖尿病数据库）的患者当中得到验证。

Sosenko说，Index60算法的目标是开发出一种方法来明确患者“谁将几乎不可避免地在一个相当短的时间内进展为糖尿病。”他和他的同事们想开发一种纯粹的代谢算法，因此他们抛开年龄和体重指数（BMI）并反而聚焦于60分钟C肽和60分钟血糖。

Sosenko今天告诉MedPage Today说：“我们提出了一个阈值，并认为该阈值是合理的保守值，在一定程度上，如果你在随访当中超过了这一阈值，那么你就极有可能患有糖尿病。”

他们报道称，研究发现当患者达到Index60值2.30或者更高时，在此参数的基础上，90%的患者都诊断有糖尿病。

研究人员报道，其中有80例患者证实Index60得分为2.30或更高，32例患者不仅2小时OGTT为200或更高，并且所有者32例患者后来依据统一标准被诊断（为糖尿病）。

Sosenko表示，如果那32例患者使用Index60标准，那么诊断将会平均提早1年得出（P<0.001）。

他告诉MedPageToday称：“一些个体较早被诊断，但对于此仍需要进一步的研究与讨论。”

哈佛大学Joslin糖尿病中心的Lori Laffel（MD, MPH）在该研究结果汇报时主持本场会议，表示这样的预测工具对于诊断疾病“在领先时间上有一个巨大的提升”。

她说：“你越早明确患者的糖尿病高发风险，β细胞的功能也就会保留越多。”

然而，Sosenko提醒道，疾病进展早期阶段的治疗仍然是需要的。研究出这样的治疗方法是TrialNet的一个主要目标。

他说：“现如今，我们尚无临床证据，但如果我们能在他们/患者还有较多胰岛素的时候早期诊断，并且给予更多可用的治疗，那么患者也会更受益。”
 

ADA: Risk Model May Catch Type 1 Diabetes Early

A threshold based on risk prediction data from a large epidemiological study of type 1 diabetes may help better predict which patients will develop the disease, researchers reported here.

A total of 90% of patients who exceeded a particular threshold on the Index60 algorithm were eventually diagnosed with type 1 diabetes, Jay Sosenko, MD, of the University of Miami, and colleagues reported during the American Diabetes Association meeting here.

"If we can capture [patients] earlier, they'll have more insulin available, and we can treat them at an earlier stage of the disease process," Sosenko said during a press briefing.

The Index60 is a proportional hazards model that is based on fasting C-peptide, 60-minute glucose, and 60-minute C-peptide of baseline oral glucose tolerance tests (OGTTs) in the Diabetes Prevention Trial -- Type 1 (DPT-1).

Sosenko said the Index60 was a progression from previous risk prediction scores that were developed out of the trial. The first was based on five characteristics: age, body mass index (BMI), fasting C-peptide, the sum of C-peptide from 30 to 120 minutes, and the sum of glucose levels 30 to 120 minutes.

Within the DPT-1, that model was highly predictive of development of type 1 diabetes and was validated in a second study of patients from TrialNet, another large diabetes database.

The goal of the Index60 algorithm was to develop a way to identify patients "who will almost inevitably get diabetes within a reasonably short period of time," Sosenko said. He and his colleagues wanted to develop a purely metabolic algorithm, so they dropped age and body mass index (BMI) and focused on 60-minute C-peptide and 60-minute glucose instead.

"We came up with a threshold that we thought was reasonably conservative in the sense that if you exceeded that threshold during follow-up, you were highly likely to get diabetes," Sosenko toldMedPage Today.

They found that when patient***** an Index60 value of 2.30 or higher, 90% of patients were diagnosed with diabetes on the basis of this parameter, they reported.

Of the 80 patients who were confirmed to have an Index60 score of 2.30 or higher, 32 patients could not also be confirmed with a 2-hour OGTT of 200 or higher -- but all 32 of these patients were later diagnosed by standard criteria, the researchers reported.

If Index60 criteria had been used in those 32 patients, Sosenko said, the diagnosis would have been made a mean of 1 year earlier (P<0.001).

"Some individuals would have been diagnosed earlier, but there needs to be further development and discussion about this," he told MedPage Today.

Lori Laffel, MD, MPH, of the Joslin Diabetes Center at Harvard, who moderated the press briefing during which the findings were presented, said such predictive tools "could give a huge increase in lead time" for diagnosing the disease.

"The earlier you can identify patients who are at high risk for diabetes," she said, "the greater the residual beta cell function."

Sosenko warned, however, that treatments that would work that early in the disease process would still be needed. Developing such treatments is a major goal of TrialNet.

"Right now we have nothing available clinically," he said, "but if we can identify people earlier when they have more insulin and there are more treatments available, then patients will be better off."

原文链接：http://www.medpagetoday.com/MeetingCoverage/ADA/40039

编辑： belinda_1231    来源：丁香园