Accounting for Age-Related Increases in HbA1c More Accurately Quantifies Risk of Type 1 Diabetes Progression in Islet Autoantibody–Positive Adults
Authors' conclusion
Age-related variation in HbA1c influences dysglycemia classification in adults at risk for type 1 diabetes. Age-adjusted HbA1c or a higher HbA1c threshold (≥6.0% [42 mmol/mol]) in adults aged ≥30 years identifies individuals with progression risk comparable to children
Study context
- Population
- Autoantibody-positive relatives at risk for T1D, TrialNet Pathway to Prevention study
- Participants
- 5,024 relatives
- Exposure
- Children vs adults; standard HbA1c ≥5.7% vs age-adjusted HbA1c vs HbA1c ≥6.0% thresholds
- Childrenn = 3,720
- Adultsn = 1,304reference
- Outcome
- Progression risk by dysglycemia threshold (HbA1c ≥5.7%, age-adjusted HbA1c, HbA1c ≥6.0%)
- Follow-up
- 1-year
Methodological detailssecondary analysis of TrialNet Pathway to Prevention study, age effects modeled in population-based Exeter 10000 cohort
- Secondary analysis of TrialNet Pathway to Prevention study
- Age effects modeled in population-based Exeter 10000 cohort
Main finding
As reported in the abstract
1-year progression risk, HbA1c ≥5.7% (39 mmol/mol)
Single autoantibody-positive
Multiple autoantibody-positive
- Children vs Adults: P < 0.001 — single and multiple autoantibody-positive (both P < 0.001)
- Multiple autoantibody-positive: Children 55% (49, 60) vs Adults 38% (27, 47)
- 55% vs 38%
Observational data: associations, not effects.
Further findings
| Outcome | Children | Adults | P value |
|---|---|---|---|
| 1-year progression risk with age-adjusted HbA1c, single autoantibody-positive | 38% (CI 28–47) | 27% (CI 13–39) | P = 0.32 |
- Adults aged <30 years vs children · similar progression risk · post hoc analyses
- P = 0.1
1-year progression risk with age-adjusted HbA1c, single autoantibody-positive
- Attenuated differences among multiple autoantibody-positive participants with age adjustment
Progression risk with HbA1c ≥6.0% (42 mmol/mol)
- Comparable progression risk between adults and children across autoantibody subgroups
Original publication
Accounting for Age-Related Increases in HbA1c More Accurately Quantifies Risk of Type 1 Diabetes Progression in Islet Autoantibody–Positive Adults. Diabetes Care. Published 6 May 2026. doi:10.
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