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

IF 3.4 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine Pub Date : 2025-05-28 DOI:10.1111/dme.70077

Rabbi Swaby, Kruthika Narayan, Claire Scudder, Julia Townson, Richard A. Oram, Kirstine J. Bell, Maria E. Craig, Colin Dayan, Paul Aveyard, Rachel E. J. Besser

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Abstract

Aims

Current guidance on how best to monitor children and young people (CYP) with early-stage type 1 diabetes is evidenced mainly by expert consensus. This systematic review and meta-analysis aims to evaluate the current evidence for tests used to predict disease progression.

Methods

Data were sourced from PubMed, Cochrane Central, Ovid Embase and Scopus. The association (hazard ratio [HR]) between test positivity and progression to stage 3 type 1 diabetes in CYP aged ≤18 years with ≥2 islet autoantibodies was examined. Data were pooled using random effects models, and the Hartung–Knapp–Sidik–Jonkman (HKSJ) method was used to adjust confidence intervals to account for greater uncertainty. The risk of bias was evaluated using the QUADAS-2 tool (CRD42023393960).

Results

In this study, 12,923 studies were identified and 285 underwent full-text review. Thirty-four studies (n = 6866 CYP, median age 11.8 years [IQR, 6.6–13.8]) were included. Overall, 2080 (30%) CYP progressed to stage 3 type 1 diabetes over a median follow-up of 5 years (IQR 2–5). The pooled HR for tests that predicted progression were: 1.40 (95% CI 1.07–1.84) for fasting glucose (OGTT), 3.19 (1.75–5.82) for 2-h glucose (OGTT), 6.43 (1.21–34.18) for the M120 above the median value, 3.12 (2.19–4.43) per 1-unit increase in Index 60 and 1.40 (1.17–1.68) per 1.1 mmol/mol increase in HbA1c (C-statistics 0.7–0.8). Evidence for other tests, including CGM, was uncertain.

Conclusions

The OGTT, its related tests (M120, Index60) and HbA1c predict progression to stage 3 in CYP with early-stage type 1 diabetes. Other tests, including CGM, need more evidence to support their use as predictive tests in this context.

Abstract Image

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用于预测早期1型糖尿病儿童疾病进展的检测方法：一项系统回顾和荟萃分析

目的：目前关于如何最好地监测儿童和青少年（CYP）早期1型糖尿病的指导主要是由专家共识证明的。本系统综述和荟萃分析旨在评估用于预测疾病进展的测试的现有证据。方法：数据来源于PubMed、Cochrane Central、Ovid Embase和Scopus。在年龄≤18岁且胰岛自身抗体≥2的CYP患者中，检测阳性与进展为3期1型糖尿病的相关性（危险比[HR]）。使用随机效应模型汇总数据，并使用Hartung-Knapp-Sidik-Jonkman （HKSJ）方法调整置信区间以考虑更大的不确定性。使用QUADAS-2工具（CRD42023393960）评估偏倚风险。结果：本研究共纳入12923项研究，其中285项进行了全文综述。纳入34项研究（n = 6866 CYP，中位年龄11.8岁[IQR， 6.6-13.8]）。总体而言，在中位5年随访期间，2080例（30%）CYP进展为3期1型糖尿病（IQR 2-5）。预测进展的试验的总危险度为：空腹血糖（OGTT） 1.40 (95% CI 1.07-1.84)， 2小时血糖（OGTT） 3.19 (95% CI 1.75-5.82)，中位数以上M120的危险度为6.43(1.21-34.18)，指数60每增加1单位3.12 (2.19-4.43)，HbA1c每增加1.1 mmol/mol 1.40 (1.17-1.68) （c统计值0.7-0.8）。其他测试的证据，包括CGM，是不确定的。结论：OGTT及其相关检测（M120、Index60）和HbA1c可预测CYP合并早期1型糖尿病患者进展至3期。其他测试，包括CGM，需要更多的证据来支持它们在这种情况下作为预测性测试的使用。

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来源期刊

Diabetic Medicine 医学-内分泌学与代谢

CiteScore

7.20

自引率

5.70%

发文量

229

审稿时长

3-6 weeks

期刊介绍： Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”