HOMA2-B enhances assessment of type 1 diabetes risk among TrialNet Pathway to Prevention participants

Abstract

Aims/hypothesis Methods to identify individuals at highest risk for type 1 diabetes are essential for the successful implementation of disease-modifying interventions. Simple metabolic measures are needed to help stratify autoantibody-positive (Aab+) individuals who are at risk of developing type 1 diabetes. HOMA2-B is a validated mathematical tool commonly used to estimate beta cell function in type 2 diabetes using fasting glucose and insulin. The utility of HOMA2-B in association with type 1 diabetes progression has not been tested. Methods Baseline HOMA2-B values from single-Aab+ (n = 2652; mean age, 21.1 ± 14.0 years) and multiple-Aab+ (n = 3794; mean age, 14.5 ± 11.2 years) individuals enrolled in the TrialNet Pathway to Prevention study were compared. Cox proportional hazard models were used to determine associations between HOMA2-B tertiles and time to progression to type 1 diabetes, with adjustments for age, sex, HLA status and BMI z score. Receiver operating characteristic (ROC) analysis was used to test the association of HOMA2-B with type 1 diabetes development in 1, 2, 5 and 10 years. Results At study entry, HOMA2-B values were higher in single-compared with multiple-Aab+ Pathway to Prevention participants (91.1 ± 44.5 vs 83.9 ± 38.9; p < 0.001). Single-and multiple-Aab+ individuals in the lowest HOMA2-B tertile had a higher risk and faster rate of progression to type 1 diabetes. For progression to type 1 diabetes within 1 year, area under the ROC curve (AUC-ROC) was 0.685, 0.666 and 0.680 for all Aab+, single-Aab+ and multiple-Aab+ individuals, respectively. When correlation between HOMA2-B and type 1 diabetes risk was assessed in combination with additional factors known to influence type 1 diabetes progression (insulin sensitivity, age and HLA status), AUC-ROC was highest for the single-Aab+ group's risk of progression at 2 years (AUC-ROC 0.723 [95% CI 0.652, 0.794]). Conclusions/interpretation These data suggest that HOMA2-B may have utility as a single-time-point measurement to stratify risk of type 1 diabetes development in Aab+ individuals.A complete list of Type 1 Diabetes TrialNet Study Group members is included in the electronic supplementary material (ESM).

Medication Deprescribing Among Patients With Type 2 Diabetes: A Qualitative Case Series of Lifestyle Medicine Practitioner Protocols

“…Comfortable with continuing a GLP-1 receptor agonist if the patient is tolerating it and has obesity. † HOMA2-β is a validated mathematical tool commonly used to estimate β-cell function in type 2 diabetes using fasting glucose and insulin ( 48 ). …”

“… † HOMA2-β is a validated mathematical tool commonly used to estimate β-cell function in type 2 diabetes using fasting glucose and insulin ( 48 ). …”

Glycated haemoglobin, HOMA2‐B, C‐peptide to glucose ratio and type 2 diabetes clusters as predictors for therapy failure in individuals with type 2 diabetes without insulin therapy: A registry analysis

“…Utilizing high HOMA2‐B plus low HOMA2‐IR as reference, the HR for insulin requirement rose with low HOMA2‐B [2.18 (1.47‐3.23)], high HOMA2‐IR [2.45 (1.64, 3.64)] and low HOMA2‐B plus high HOMA2‐IR [4.25 (2.82, 6.41)] adjusted for sex, age and disease 21 . In addition, in people at risk of type 1 diabetes development (positive autoantibodies without overt hyperglycaemia), HOMA2‐B has been suggested as a risk predictor for the need of insulin therapy 22 . The CGR (glucose in mg/dl divided through C‐peptide in ng/ml) was suggested by Fritsche et al to predict the need for insulin 9 .…”

“…21 In addition, in people at risk of type 1 diabetes development (positive autoantibodies without overt hyperglycaemia), HOMA2-B has been suggested as a risk predictor for the need of insulin therapy. 22 The CGR (glucose in mg/dl divided through C-peptide in ng/ml) was suggested by Fritsche et al to predict the need for insulin. 9 The authors proposed that if CGR was <2, an insulin treatment should be initiated; basal insulin therapy in combination with other antihyperglycaemic agents is recommended in those with CGR of 2-5, while in those having a CGR >5 it is assumed that insulin is not necessary at this stage and oral agents should be sufficient to control glycaemia.…”