USA: Recent data suggest that HOMA2-B may be useful as a single-time-point measurement for stratifying the risk of developing type 1 diabetes (T1D) in autoantibody-positive (Aab+) individuals. The study appears in the journal Diabetologia.
Methods for identifying people at highest risk of type 1 diabetes are important for the successful implementation of disease-modifying interventions. There is a need for simple metabolic measures to help stratify Aab+ people at risk of developing type 1 diabetes. HOMA2-B is a validated mathematical tool used commonly to estimate beta cell function in type 2 diabetes using fasting glucose and insulin. However, the use of HOMA2-B with regard to type 1 diabetes progression has not been tested.
Against the above background, Carmella Evans-Molina, Roudebush VA Medical Center, Indianapolis, IN, USA, and colleagues aimed to assess whether HOMA2-B is associated with risk of type 1 diabetes progression.
The study included individuals enrolled in the TrialNet Pathway to Prevention study. 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) were compared. The associations between HOMA2-B tertiles and time to progression to type 1 diabetes were determined after adjusting 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.
Following were the study's key findings:
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).
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).
"These findings suggest that HOMA2-B may have utility as a single-time-point measurement to stratify risk of type 1 diabetes development in Aab+ individuals," the authors concluded.
Reference:
Felton, J.L., Cuthbertson, D., Warnock, M. et al. HOMA2-B enhances assessment of type 1 diabetes risk among TrialNet Pathway to Prevention participants. Diabetologia 65, 88–100 (2022). https://doi.org/10.1007/s00125-021-05573-6