风险评分能预测1型糖尿病

芝加哥——根据迈阿密大学医学和流行病学教授Jay M. Sosenko医生在美国糖尿病学会(ADA)2013年会上报告的一项研究结果，由迈阿密大学研究人员开发的一种风险评分对症状性1型糖尿病的诊断具有很高的预测效力。这种风险评分或其改进版很可能会成为1型糖尿病的新诊断方法，有利于对该病进行早期干预和预防。

该风险评分是在对发生1型糖尿病预测力最强的几个变量的基础上建立的，其中包括体重指数、年龄、空腹C肽水平、C肽生成总量的一项衡量指标，以及总血糖的一项衡量指标。迄今为止，该研究的结果已显示，风险评分超过某个阈值者在大致2年内发生症状性1型糖尿病的概率很高。

Sosenko医生为了探讨风险评分，对1型糖尿病预防试验(DPT1)的数据库进行了分析，随后将DPT1风险评分(DPTRS)应用到大型多中心研究——TrialNet自然史研究(亦称“预防途径研究”)的数据中。结果表明，DPTRS甚至能识别糖耐量正常但有发病风险的人群，这在一定程度上是因为它考虑了年龄因素。目前用于识别高危个体的血糖代谢异常是基于成人血糖阈值确立的，而这些阈值可能不适用于儿童。Sosenko医生在会上还讨论了DPTRS的临床适用性。

青少年糖尿病研究基金会首席科学官Richard A. Insel医生表示，该领域今后的研发成果最终很可能会促成儿童血糖普查，再往前说就是儿童1型糖尿病预防性免疫接种；不过与此同时，为了预防酮症酸中毒的发生，每个人都应该知道糖尿病的症状，糖尿病酮症酸中毒的发生率在近20年中始终没有改善，许多患者未得到诊断。因此，从教师到家长再到医务人员，每个人都应该知道糖尿病的症状，这样大家齐心努力就能预防酮症酸中毒，尤其是在儿童患者中。

Sosenko医生没有利益冲突披露。TrialNet由美国国家糖尿病、消化病与肾病研究所资助，并获得了ADA和JDRF的支持。

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By: NASSEM S. MILLER, Clinical Endocrinology News Digital Network

CHIGAGO – In their ongoing quest to refine and identify methods for earlier intervention and prevention of type 1 diabetes, researchers at the University of Miami have developed a risk score, which includes the individual's age, and so far has shown to be highly predictive of symptomatic type 1 diabetes diagnosis. The risk score, or a modification of it, "could potentially provide an additional means for diagnosing type 1 diabetes," said Dr. Jay M. Sosenko, professor of medicine and epidemiology at the University of Miami.

The risk score is based on variables that are most predictive of who would develop symptomatic type 1 diabetes, including body mass index, age, fasting C-peptide levels, a measure of overall C-peptide production, and a measure of overall glucose. So far, the study has shown individuals whose risk scores passed a certain threshold were highly likely to develop symptomatic type 1 diabetes within roughly 2 years.

Dr. Sosenko analyzed the Diabetes Prevention Trial of Type 1 Diabetes (DPT1) database to identify the risk scores. He then applied the DPT1 Risk Score, or DPTRS, to data from the large, multi-center study TrialNet Natural History Study, which is also known as the Pathway to Prevention Study. He spoke about his findings during the annual American Diabetes Association Meeting.

"The DPTRS can identify even those who have normal glucose tolerance but who are nonetheless at risk, in part because it takes age into account," he said in a news release. "Dysglycemia, which is currently used to identify high risk individuals, is based upon the glucose thresholds of adults and these thresholds might not be appropriate for children," said Dr. Sosenko.

In this video, Dr. Sosenko speaks about the clinical applicability of DPTRS. The ongoing developments in the field could ultimately lead to universal childhood screening and further on, immunization of children "to prevent the ongoing process associated with type 1 diabetes from taking hold," said Dr. Richard A. Insel, chief scientific officer for the Juvenile Diabetes Research Foundation.

But in the meantime, "everybody should be aware of the symptoms of diabetes to prevent the onset of ketoacidosis," said Dr. Insel. "The rate of diabetic ketoacidosis hasn't changed over the last 20 years, and many of these individuals are being seen in the health care system and not being diagnosed. So everybody from teachers to parents to health care providers should be aware of symptoms of diabetes so we can prevent ketoacidosis, especially in children."

Dr. Sosenko had no disclosures. TrialNet is sponsored by the National Institute of Diabetes and Digestive and Kidney Disease, and receives support from the ADA and the JDRF.