Insulin Dose–Adjusted Hemoglobin A1c Has Suboptimal Performance for Identifying C-Peptide–Defined Partial Remission: The SEARCH for Diabetes in Youth Study
Authors' conclusion
IDAA1c ≤9 demonstrated suboptimal accuracy as a screening test for partial remission, especially underestimating β-cell function in youth with overweight or obesity. BMI-specific cutoffs improved sensitivity but reduced specificity.
Study context
- Population
- SEARCH for Diabetes in Youth participants with T1D and mixed-meal tolerance test (MMTT)-stimulated C-peptide within 12 months of diagnosis
- Participants
- 422 participants
- Comparison
- IDAA1c ≤9 vs MMTT-stimulated C-peptide–defined partial remission
- Outcome
- Sensitivity, specificity and ROC AUC of IDAA1c ≤9 for identifying partial remission
Performance
As reported in the abstract
Partial remission (C-peptide ≥0.91 ng/mL), overall
| Test or model | Sensitivity | Specificity | ROC AUC |
|---|---|---|---|
| IDAA1c ≤9 | 61% | 79% | 0.77 |
IDAA1c ≤9
Sensitivity61%
Specificity79%
ROC AUC0.77
Further findings
- Youden index-derived cutoff IDAA1c ≤11.6, subgroup with overweight or obesity
- 93% · sensitivity · specificity 54%
Accuracy of IDAA1c ≤9 for partial remission, subgroup with overweight or obesity
- Sensitivity, overweight or obesity
- 45%
- Specificity, overweight or obesity
- 81%
IDAA1c and stimulated C-peptide by BMI category (normal or underweight vs overweight or obesity)
- IDAA1c, normal or underweight vs overweight or obesity (P = 0.043)
- 8.95 vs. 9.28
- Stimulated C-peptide, normal or underweight vs overweight or obesity, ng/mL (P < 0.001)
- 1.25 vs. 1.88
Original publication
Insulin Dose–Adjusted Hemoglobin A1c Has Suboptimal Performance for Identifying C-Peptide–Defined Partial Remission: The SEARCH for Diabetes in Youth Study. Diabetes Care. Published 29 September 2026. doi:10.
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