We and others
previously demonstrated that a type 1 diabetes genetic risk score (GRS) improves
the ability to predict disease progression and onset in at-risk subjects with
islet autoantibodies. Here, we hypothesized that GRS and islet autoantibodies,
combined with age at onset and disease duration, could serve as markers of
residual β-cell function following type 1 diabetes diagnosis. Generalized
estimating equations were used to investigate whether GRS along with insulinoma-associated
protein-2 autoantibody (IA-2A), zinc transporter 8 autoantibody (ZnT8A) and GAD
autoantibody (GADA) titers were predictive of C-peptide detection in a largely
cross-sectional cohort of 401 subjects with type 1 diabetes (duration median = 4.5
years, range 0-60). Indeed, a combined model incorporating disease duration,
age at onset, GRS, and titers of IA-2A, ZnT8A and GADA provided superior
capacity to predict C-peptide detection (QIC=334.6) compared with disease
duration, age at onset, and GRS as the sole parameters (QIC=359.2). These
findings support the need for longitudinal validation of our combinatorial
model. The ability to project the rate and extent of decline in residual C-peptide
production for individuals with type 1 diabetes could critically inform enrollment
and benchmarking for clinical trials seeking to preserve or restore endogenous
β-cell function.