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Developing a T1D Prediction Model

Jul 20, 2021
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Anina Pham, PharmD. Candidate, Lake Erie College of Osteopathic Medicine, College of Pharmacy

Study using autoantibody testing finds type 1 diabetes may account for 8% of diabetes cases in young adults. 

Type 1 diabetes has a strong genetic component. The genes HLA-DR3 or HLA-DR4, which are linked to autoimmune disease, are present in most white people with type 1 diabetes. Genes that may put other ethnic groups at risk are not as well-studied, but researchers have identified some they believe may increase risk, such as the HLA-DR7 gene in African Americans and the HLA-DR9 gene in Japanese people. Diabetes autoantibody testing (DAA) can be used to screen family members of people with type 1 to assess their risk for developing the disease themselves.  

 

A recent study in California identified young adults, ages 20 to 45, newly diagnosed with diabetes by Kaiser Permanente’s healthcare system. The reason for the study was to measure the incidence of type 1 diabetes in young adults. The study also developed a prediction model to better understand young adults with type 1 diabetes compared to type 2 diabetes. All the patients are diagnosed with diabetes and asked to do the diabetes autoantibody test. 

Out of the 2,347,989 at-risk participants, they discovered that 7,862 developed diabetes, 2,063 had the diabetes autoantibody, and 166 had ≥1 positive DAA. T1D IR (95% CI) per 100,000 person-years was 15.2 (10.2-20.1) for ages 20-29 and 38.2 (28.6-47.8) for ages 30-44 years. The age-standardized IRs were 32.5 (22.2-42.8) for men and 27.2 (21.0-34.5) for women. The age/sex-standardized IRs were 30.1 (23.5-36.8) overall; 41.4 (25.3-57.5) for Hispanics, 37.0 (11.6-62.4) for Blacks, 21.4 (14.3-28.6) for non-Hispanic Whites, and 19.4 (8.5-30.2) for Asians. Predictors of T1D among cases included female sex, younger age, lower BMI, insulin use and having T1D based on diagnostic codes.  

The study results illustrate type 1 diabetes, in these young adults, to be up to 8% of all diabetes cases among the age group. The onset of type 1 diabetes in young adults was compared to children and resulted in higher non-Hispanic black versus non-Hispanic white individuals.  

There are some limitations to the study. The study should have included if it was randomized; however, we are unsure. How were participants asked to conduct the research? What is the antibody testing process? Were the participants evenly chosen for the female and male populations? What is the likelihood of other ethnicities at risk for type 1 diabetes? Adding these suggestions could improve the study to understand type 1 diabetes in the future better. 

  

Practice Pearls: 

  • Young females with a lower body mass index were linked to having type 1 diabetes in the study compared to young males. 
  • Based on the study, up to 8% of newly diagnosed young adults with diabetes have type 1 diabetes. 
  • Finding out you are diagnosed with type 1 diabetes early is the key to starting the proper therapeutic management and reducing other acute complications. 

 

Achenbach, Peter et al. “Predicting type 1 diabetes.” Current Diabetes Reports. Apr 5, 2005. 

“Genetics of Diabetes.” Genetics of Diabetes. American Diabetes Association. 

Lawrence, J. et al. “Incidence and Predictors of Type 1 Diabetes Among Young Adults.” Diabetes Research and Clinical Practice. Dec 24, 2020. 

 

Anina Pham, PharmD. Candidate, Lake Erie College of Osteopathic Medicine, College of Pharmacy