Aims To assess the clinical utility of two polygenic scores (PGSs) in differentiating between type 1/type 2 diabetes. Methods Patients diagnosed with diabetes in the UK Biobank were studied (N = 41,787), including 464 (1%) and 15,923 (38%) who met the criteria for classic type 1 and type 2 diabetes, respectively, and 25,400 (61%) atypical diabetes. The validity of two published PGSs for type 1 (PGST1D) and type 2 diabetes (PGST2D) in differentiating classic type 1/type 2 diabetes was assessed using C-statistic. The utility of genetic probability for type 1 diabetes based on PGSs (GenProb-T1D) was evaluated in atypical diabetes patients. Results The joint performance of PGST1D and PGST2D for differentiating classic type 1/type 2 diabetes was outstanding (C-statistic = 0.91), significantly higher than that of PGST1D alone (0.88) and PGST2D alone (0.70), both P < 0.001. Using an optimal cutoff of GenProb-T1D, 23% of patients with atypical diabetes had a higher probability of type 1 diabetes and its validity was independently supported by clinical presentations that are characteristics of type 1 diabetes. Conclusion PGST1D and PGST2D can be used to discriminate classic type 1/type 2 diabetes and have potential clinical utility for differentiating these two types of diseases among patients with atypical diabetes.

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Background: Although men of African ancestry (AA) have the highest mortality rate from prostate cancer (PCa), relatively little is known about the germline variants that are associated with PCa risk in AA men.The goal of this study is to systematically evaluate rare, recurrent nonsynonymous variants across the exome for their association with PCa in AA men.Methods: Whole exome sequencing (WES) of germline DNA in two AA PCa patient cohorts of Johns Hopkins Hospital (N=960) and Wayne State University (N=747) was performed. All nonsynonymous variants presented in both case cohorts, with a carrier rate between 0.3% and 1%, were identi ed. Their carrier rates were compared with rates from 8,128 African/African American (AFR) control subjects fromThe Genome Aggregation Database (gnomAD) using Fisher's exact test. Signi cant variants, de ned as false discovery rate (FDR) adjusted p-value £0.05, were further evaluated in AA PCa cases (N=132) and controls (N=1,184) from the UK Biobank (UKB).Results: Two variants reached a pre-speci ed statistical signi cance level. The rst was p.R14Q in GPRC5C (found in 0.47% of PCa cases and 0.01% of population controls); odds ratio (OR) for PCa was 37.46 (95%CI 4.68-299.72), pexact=7.01E-06, FDR adjusted p-value=0.05. The second was p.R511Q in IGF1R (found in 0.53% of PCa cases and 0.01% of population controls); OR for PCa was 21.54 (95%CI 4.65-99.76), pexact=5.51E-06, FDR adjusted p-value=0.05. The mean percentage of African ancestry was similar between variant carriers and non-carriers of each variant, p>0.05. In the UKB AA men, GPRC5C R14Q was 0.76% and 0.08% in cases and controls, respectively, OR for PCa was 9.00 (95%CI 0.56-145.23), pexact =0.19. However, IGF1R R511Q was not found in cases or controls.Conclusions: This WES study identi ed two rare, recurrent nonsynonymous PCa risk-associated variants in AA. Con rmation in additional large populations of AA PCa cases and controls is required.