Improving Type 1 Diabetes Risk Assessment in Adults

Graphical Abstract @LauricFerratUNIGE/Image

A new study published in Diabetes Care proposes a more accurate approach for assessing the risk of progression to type 1 diabetes (T1D) in adults who test positive for islet autoantibodies associated with the disease.

HbA1c, a widely used marker reflecting average blood glucose levels over several months, plays an important role in identifying individuals at high risk of developing T1D. However, HbA1c levels naturally increase with age, even in people without diabetes. As a result, the same HbA1c threshold may reflect very different levels of risk in children and adults.

In this study, researchers analyzed data from more than 5,000 participants in the international TrialNet study to determine whether the current dysglycemia threshold (HbA1c ≥5.7%) overestimates progression risk in adults with autoantibodies. The findings showed that adults with the same HbA1c levels as children had a substantially lower risk of progressing to clinical type 1 diabetes.

The researchers then evaluated two alternative approaches: adjusting HbA1c according to age and applying a higher HbA1c threshold in adults. They found that using a threshold of 6.0% in adults aged 30 years and older resulted in progression risks more comparable to those observed in children and younger adults using the standard 5.7% threshold.

These findings are particularly relevant in the context of the global expansion of early T1D screening and the emergence of treatments such as teplizumab, which can delay the onset of clinical disease. More accurate risk stratification could help reduce unnecessary concern, limit false-positive classifications, and improve identification of individuals who may benefit from closer monitoring or preventive interventions.

The study also highlights the importance of age-specific approaches to T1D risk assessment in order to improve the precision of screening and prevention strategies in clinical practice.

Full article >> https://doi.org/10.2337/dc26-0446

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