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Testing methods used to predict disease progression in children with early-stage type 1 diabetes: A systematic review

Rabbi Swaby1, Kruthika Narayan2,3, Claire Scudder1

  • 1Centre for Human Genetics, Nuffield Department of Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.

Diabetic Medicine : a Journal of the British Diabetic Association
|May 29, 2025
PubMed

Insights

Oral glucose tolerance tests (OGTT) and HbA1c effectively predict type 1 diabetes progression in children and young people. More research is needed for continuous glucose monitoring (CGM) and other tests.

Area of Science:

  • Endocrinology
  • Pediatrics
  • Metabolic Diseases

Background:

  • Current guidelines for monitoring early-stage type 1 diabetes in children and young people (CYP) rely heavily on expert consensus.
  • There is a need for evidence-based predictive tests to monitor disease progression in this population.

Purpose of the Study:

  • To systematically review and meta-analyze the evidence for tests that predict disease progression in CYP with early-stage type 1 diabetes.
  • To identify reliable biomarkers for monitoring the transition to stage 3 type 1 diabetes.

Main Methods:

  • A systematic search of PubMed, Cochrane Central, Ovid Embase, and Scopus was conducted.
  • Hazard ratios (HR) for progression to stage 3 type 1 diabetes were pooled using random effects models for CYP (≤18 years) with ≥2 islet autoantibodies.
  • Risk of bias was assessed using the QUADAS-2 tool.

Main Results:

  • Thirty-four studies including 6866 CYP were analyzed, with 30% progressing to stage 3 diabetes over a median of 5 years.
  • Tests predicting progression included fasting glucose (HR 1.40), 2-h glucose (HR 3.19) from OGTT, M120 (HR 6.43), Index60 (HR 3.12), and HbA1c (HR 1.40).
  • Evidence for continuous glucose monitoring (CGM) and other tests was inconclusive.

Conclusions:

  • Oral glucose tolerance tests (OGTT), including M120 and Index60, and HbA1c are effective predictors of stage 3 type 1 diabetes progression in CYP.
  • Further research is required to validate the predictive utility of tests like CGM in this demographic.
Abstract

Keywords:
autoimmunitychildren and adolescentsprediction of diabetestype 1 diabetes

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