OGTT Metrics Surpass Continuous Glucose Monitoring Data for T1D Prediction in Multiple-Autoantibody-Positive...

Area of Science:

• Endocrinology
• Metabolic Diseases
• Clinical Trials

Background:

• Type 1 diabetes (T1D) prediction in autoantibody-positive (AAB) individuals is crucial for clinical trials.
• The utility of continuous glucose monitoring (CGM) versus oral glucose tolerance tests (OGTT) for T1D progression prediction remains unclear.

Purpose of the Study:

• To compare the predictive accuracy of CGM-based metrics against OGTT-based metrics for T1D development.
• To evaluate CGM's potential role in monitoring AAB-positive individuals within T1D clinical trials.

Main Methods:

• A cohort of 93 multiple-AAB-positive individuals from the TrialNet Pathway to Prevention (TN01) study underwent CGM at baseline, 6, and 12 months.
• Receiver operating characteristic (ROC) curve analysis was used to compare the predictive performance of CGM and OGTT metrics for T1D diagnosis.

Main Results:

• Several CGM metrics and most OGTT metrics differed significantly between individuals who developed T1D and those who did not.
• While CGM metrics showed some predictive ability (AUC 50-69%), OGTT-derived variables (Index60, DPTRS) demonstrated superior discriminative ability (AUC ~80%).

Conclusions:

• Continuous glucose monitoring (CGM) shows predictive value for T1D in AAB-positive individuals but is less effective than OGTT-derived metrics.
• Current evidence suggests OGTT remains the preferred method for T1D prediction in clinical trials, though CGM may offer feasibility advantages in certain contexts.