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首页> 外文期刊>Diabetes care >A Type 1 Diabetes Genetic Risk Score Can Identify Patients With GAD65 Autoantibody-Positive Type 2 Diabetes Who Rapidly Progress to Insulin Therapy
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A Type 1 Diabetes Genetic Risk Score Can Identify Patients With GAD65 Autoantibody-Positive Type 2 Diabetes Who Rapidly Progress to Insulin Therapy

机译:1型糖尿病遗传风险评分可以鉴定GAD65自身抗体阳性2型糖尿病患者,他们迅速进入胰岛素治疗

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摘要

OBJECTIVEProgression to insulin therapy in clinically diagnosed type 2 diabetes is highly variable. GAD65 autoantibodies (GADA) are associated with faster progression, but their predictive value is limited. We aimed to determine if a type 1 diabetes genetic risk score (T1D GRS) could predict rapid progression to insulin treatment over and above GADA testing.RESEARCH DESIGN AND METHODSWe examined the relationship between T1D GRS, GADA (negative or positive), and rapid insulin requirement (within 5 years) using Kaplan-Meier survival analysis and Cox regression in 8,608 participants with clinical type 2 diabetes (onset 35 years and treated without insulin for 6 months). T1D GRS was both analyzed continuously (as standardized scores) and categorized based on previously reported centiles of a population with type 1 diabetes (5th [low], 5th-50th [medium], and 50th [high]).RESULTSIn GADA-positive participants (3.3%), those with higher T1D GRS progressed to insulin more quickly: probability of insulin requirement at 5 years (95% CI): 47.9% (35.0%, 62.78%) (high T1D GRS) vs. 27.6% (20.5%, 36.5%) (medium T1D GRS) vs. 17.6% (11.2%, 27.2%) (low T1D GRS); P = 0.001. In contrast, T1D GRS did not predict rapid insulin requirement in GADA-negative participants (P = 0.4). In Cox regression analysis with adjustment for age of diagnosis, BMI, and cohort, T1D GRS was independently associated with time to insulin only in the presence of GADA: hazard ratio per SD increase was 1.48 (1.15, 1.90); P = 0.002.CONCLUSIONSA T1D GRS alters the clinical implications of a positive GADA test in patients with clinical type 2 diabetes and is independent of and additive to clinical features.
机译:OBJECTIVEProgression在临床诊断的2型糖尿病的胰岛素治疗是高度可变的。 GAD65自身抗体(GADA)与更快的进展相关,但它们的预测值是有限的。我们的目的是确定是否有1型糖尿病的遗传风险评分(T1D GRS)可以预测快速进展至胰岛素治疗之上GADA testing.RESEARCH设计和METHODSWe检查T1D GRS,GADA(正或负),以及快速胰岛素之间的关系要件(5年之内),使用Kaplan-Meier生存分析和Cox回归在8608名参与者临床2型糖尿病(发病→35年,无胰岛素用于治疗6个月)。 T1D GRS既是连续分析(如标准化分数)和1型糖尿病患者的基于分类的群体的先前报道的百分位数(小于第五[低],第五-第50 [培养基],和大于50次[高])。RESULTSIn GADA阳性的参与者(3.3%),具有较高的1型糖尿病进展GRS对胰岛素更迅速:胰岛素需求的概率在5年(95%CI):47.9%(35.0%,62.78%)(高T1D GRS)与27.6 %(20.5%,36.5%)(介质T1D GRS)与17.6%(11.2%,27.2%)(低T1D GRS); P = 0.001。相比之下,T1D GRS没有预测在GADA阴性的参与者(P = 0.4)快速胰岛素需要量。在调整用于诊断,BMI,和队列的年龄Cox回归分析,T1D GRS独立与时间仅在GADA的存在相关联的胰岛素:每SD增加危险比为1.48(1.15,1.90); P = 0.002.CONCLUSIONSA T1D GRS涂改患者正GADA测试的临床意义的临床2型糖尿病,是独立的和添加剂的临床特征。

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  • 来源
    《Diabetes care》 |2019年第2期|共7页
  • 作者单位

    Univ Exeter Natl Inst Hlth Res Exeter Clin Res Facil Sch Med Exeter Devon England;

    Univ Exeter Natl Inst Hlth Res Exeter Clin Res Facil Sch Med Exeter Devon England;

    Vrije Univ Amsterdam Med Ctr Amsterdam Publ Hlth Res Inst Dept Epidemiol &

    Biostat Amsterdam;

    Univ Dundee Ninewells Hosp &

    Med Sch Sch Med Div Mol &

    Clin Med Dundee Scotland;

    Univ Exeter Natl Inst Hlth Res Exeter Clin Res Facil Sch Med Exeter Devon England;

    Univ Exeter Natl Inst Hlth Res Exeter Clin Res Facil Sch Med Exeter Devon England;

    Univ Dundee Ninewells Hosp &

    Med Sch Sch Med Div Mol &

    Clin Med Dundee Scotland;

    Vrije Univ Amsterdam Med Ctr Dept Gen Practice &

    Elderly Care Med Amsterdam Publ Hth Res Inst;

    Univ Dundee Ninewells Hosp &

    Med Sch Sch Med Div Mol &

    Clin Med Dundee Scotland;

    Vrije Univ Amsterdam Med Ctr Dept Gen Practice &

    Elderly Care Med Amsterdam Publ Hth Res Inst;

    Univ Exeter Natl Inst Hlth Res Exeter Clin Res Facil Sch Med Exeter Devon England;

    Vrije Univ Amsterdam Med Ctr Amsterdam Publ Hlth Res Inst Dept Epidemiol &

    Biostat Amsterdam;

    Vrije Univ Amsterdam Med Ctr Amsterdam Publ Hlth Res Inst Dept Epidemiol &

    Biostat Amsterdam;

    Univ Dundee Ninewells Hosp &

    Med Sch Sch Med Div Mol &

    Clin Med Dundee Scotland;

    Univ Exeter Natl Inst Hlth Res Exeter Clin Res Facil Sch Med Exeter Devon England;

    Univ Exeter Natl Inst Hlth Res Exeter Clin Res Facil Sch Med Exeter Devon England;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 内分泌腺疾病及代谢病;
  • 关键词

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