학술논문
Type 1 Diabetes Genetic Risk in 109,954 Veterans With Adult-Onset Diabetes: The Million Veteran Program (MVP).
Document Type
Academic Journal
Author
Yang PK; Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.; Atlanta Veterans Administration Medical Center, Atlanta, GA.; Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.; Jackson SL; Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.; Charest BR; Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA.; Cheng YJ; Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.; Sun YV; Atlanta Veterans Administration Medical Center, Atlanta, GA.; Rollins School of Public Health, Emory University, Atlanta, GA.; Raghavan S; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO.; University of Colorado School of Medicine, Denver, CO.; Litkowski EM; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO.; University of Colorado School of Medicine, Denver, CO.; Legvold BT; Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA.; Rhee MK; Atlanta Veterans Administration Medical Center, Atlanta, GA.; Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA.; Oram RA; College of Medicine and Health, University of Exeter Medical School, Devon, U.K.; Kuklina EV; Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.; Vujkovic M; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.; Reaven PD; Phoenix Veterans Affairs Health Care System, Phoenix, AZ.; Cho K; Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA.; Brigham and Women's Hospital, Boston, MA.; Leong A; Harvard Medical School, Boston, MA.; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA.; Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA.; Wilson PWF; Atlanta Veterans Administration Medical Center, Atlanta, GA.; Rollins School of Public Health, Emory University, Atlanta, GA.; College of Medicine and Health, University of Exeter Medical School, Devon, U.K.; Zhou J; Phoenix Veterans Affairs Health Care System, Phoenix, AZ.; UCLA Department of Medicine, University of California, Los Angeles, CA.; Miller DR; Bedford Veterans Affairs Medical Center, Bedford, MA.; Sharp SA; Division of Endocrinology and Diabetes, Stanford University, Palo Alto, CA.; Staimez LR; Rollins School of Public Health, Emory University, Atlanta, GA.; North KE; Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.; Highland HM; Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.; Phillips LS; Atlanta Veterans Administration Medical Center, Atlanta, GA.; Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
Source
Publisher: American Diabetes Association Country of Publication: United States NLM ID: 7805975 Publication Model: Print Cited Medium: Internet ISSN: 1935-5548 (Electronic) Linking ISSN: 01495992 NLM ISO Abbreviation: Diabetes Care Subsets: MEDLINE
Subject
Language
English
Abstract
Objective: To characterize high type 1 diabetes (T1D) genetic risk in a population where type 2 diabetes (T2D) predominates.
Research Design and Methods: Characteristics typically associated with T1D were assessed in 109,594 Million Veteran Program participants with adult-onset diabetes, 2011-2021, who had T1D genetic risk scores (GRS) defined as low (0 to <45%), medium (45 to <90%), high (90 to <95%), or highest (≥95%).
Results: T1D characteristics increased progressively with higher genetic risk (P < 0.001 for trend). A GRS ≥90% was more common with diabetes diagnoses before age 40 years, but 95% of those participants were diagnosed at age ≥40 years, and their characteristics resembled those of individuals with T2D in mean age (64.3 years) and BMI (32.3 kg/m2). Compared with the low-risk group, the highest-risk group was more likely to have diabetic ketoacidosis (low GRS 0.9% vs. highest GRS 3.7%), hypoglycemia prompting emergency visits (3.7% vs. 5.8%), outpatient plasma glucose <50 mg/dL (7.5% vs. 13.4%), a shorter median time to start insulin (3.5 vs. 1.4 years), use of a T1D diagnostic code (16.3% vs. 28.1%), low C-peptide levels if tested (1.8% vs. 32.4%), and glutamic acid decarboxylase antibodies (6.9% vs. 45.2%), all P < 0.001.
Conclusions: Characteristics associated with T1D were increased with higher genetic risk, and especially with the top 10% of risk. However, the age and BMI of those participants resemble those of people with T2D, and a substantial proportion did not have diagnostic testing or use of T1D diagnostic codes. T1D genetic screening could be used to aid identification of adult-onset T1D in settings in which T2D predominates.
(© 2024 by the American Diabetes Association.)
Research Design and Methods: Characteristics typically associated with T1D were assessed in 109,594 Million Veteran Program participants with adult-onset diabetes, 2011-2021, who had T1D genetic risk scores (GRS) defined as low (0 to <45%), medium (45 to <90%), high (90 to <95%), or highest (≥95%).
Results: T1D characteristics increased progressively with higher genetic risk (P < 0.001 for trend). A GRS ≥90% was more common with diabetes diagnoses before age 40 years, but 95% of those participants were diagnosed at age ≥40 years, and their characteristics resembled those of individuals with T2D in mean age (64.3 years) and BMI (32.3 kg/m2). Compared with the low-risk group, the highest-risk group was more likely to have diabetic ketoacidosis (low GRS 0.9% vs. highest GRS 3.7%), hypoglycemia prompting emergency visits (3.7% vs. 5.8%), outpatient plasma glucose <50 mg/dL (7.5% vs. 13.4%), a shorter median time to start insulin (3.5 vs. 1.4 years), use of a T1D diagnostic code (16.3% vs. 28.1%), low C-peptide levels if tested (1.8% vs. 32.4%), and glutamic acid decarboxylase antibodies (6.9% vs. 45.2%), all P < 0.001.
Conclusions: Characteristics associated with T1D were increased with higher genetic risk, and especially with the top 10% of risk. However, the age and BMI of those participants resemble those of people with T2D, and a substantial proportion did not have diagnostic testing or use of T1D diagnostic codes. T1D genetic screening could be used to aid identification of adult-onset T1D in settings in which T2D predominates.
(© 2024 by the American Diabetes Association.)