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Time to glucose peak during an oral glucose tolerance test identifies prediabetes risk.

ABSTRACT: CONTEXT:Morphological characteristics of the glucose curve during an oral glucose tolerance test (OGTT) (time to peak and shape) may reflect different phenotypes of insulin secretion and action, but their ability to predict diabetes risk is uncertain. OBJECTIVE:To compare the ability of time to glucose peak and curve shape to detect prediabetes and ?-cell function. DESIGN AND PARTICIPANTS:In a cross-sectional evaluation using an OGTT, 145 adults without diabetes (age 42±9 years (mean±SD), range 24-62 years, BMI 29.2±5.3 kg/m2 , range 19.9-45.2 kg/m2 ) were characterized by peak (30 minutes vs >30 minutes) and shape (biphasic vs monophasic). MAIN OUTCOME MEASURES:Prediabetes and disposition index (DI)-a marker of ?-cell function. RESULTS:Prediabetes was diagnosed in 36% (52/145) of participants. Peak>30 minutes, not monophasic curve, was associated with increased odds of prediabetes (OR: 4.0 vs 1.1; P<.001). Both monophasic curve and peak>30 minutes were associated with lower DI (P?.01). Time to glucose peak and glucose area under the curves (AUC) were independent predictors of DI (adjR2 =0.45, P<.001). CONCLUSION:Glucose peak >30 minutes was a stronger independent indicator of prediabetes and ?-cell function than the monophasic curve. Time to glucose peak may be an important tool that could enhance prediabetes risk stratification.

SUBMITTER: Chung ST

PROVIDER: S-EPMC5658251 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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Time to glucose peak during an oral glucose tolerance test identifies prediabetes risk.

Chung Stephanie T ST Ha Joon J Onuzuruike Anthony U AU Kasturi Kannan K Galvan-De La Cruz Mirella M Bingham Brianna A BA Baker Rafeal L RL Utumatwishima Jean N JN Mabundo Lilian S LS Ricks Madia M Sherman Arthur S AS Sumner Anne E AE

Clinical endocrinology 20170806 5

<h4>Context</h4>Morphological characteristics of the glucose curve during an oral glucose tolerance test (OGTT) (time to peak and shape) may reflect different phenotypes of insulin secretion and action, but their ability to predict diabetes risk is uncertain.<h4>Objective</h4>To compare the ability of time to glucose peak and curve shape to detect prediabetes and β-cell function.<h4>Design and participants</h4>In a cross-sectional evaluation using an OGTT, 145 adults without diabetes (age 42±9 y ...[more]

PMID: 28681942

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Project description:Aims/hypothesisWe aimed to examine: (1) whether specific glucose-response curve shapes during OGTTs are predictive of type 1 diabetes development; and (2) the extent to which the glucose-response curve is influenced by insulin secretion.MethodsAutoantibody-positive relatives of people with type 1 diabetes whose baseline OGTT met the definition of a monophasic or biphasic glucose-response curve were followed for the development of type 1 diabetes (n = 2627). A monophasic curve was defined as an increase in OGTT glucose between 30 and 90 min followed by a decline of ≥ 0.25 mmol/l between 90 and 120 min. A biphasic response curve was defined as a decrease in glucose after an initial increase, followed by a second increase of ≥ 0.25 mmol/l. Associations of type 1 diabetes risk with glucose curve shapes were examined using cumulative incidence curve comparisons and proportional hazards regression. C-peptide responses were compared with and without adjustments for potential confounders.ResultsThe majority of participants had a monophasic curve at baseline (n = 1732 [66%] vs n = 895 [34%]). The biphasic group had a lower cumulative incidence of type 1 diabetes (p < 0.001), which persisted after adjustments for age, sex, BMI z score and number of autoantibodies (p < 0.001). Among the monophasic group, the risk of type 1 diabetes was greater for those with a glucose peak at 90 min than for those with a peak at 30 min; the difference persisted after adjustments (p < 0.001). Compared with the biphasic group, the monophasic group had a lower early C-peptide (30-0 min) response, a lower C-peptide index (30-0 min C-peptide/30-0 min glucose), as well as a greater 2 h C-peptide level (p < 0.001 for all).Conclusions/interpretationThose with biphasic glucose curves have a lower risk of progression to type 1 diabetes than those with monophasic curves, and the risk among the monophasic group is increased when the glucose peak occurs at 90 min than at 30 min. Differences in glucose curve shapes between the monophasic and biphasic groups appear to be related to C-peptide responses.

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Time to glucose peak during an oral glucose tolerance test identifies prediabetes risk.

Publications

Time to glucose peak during an oral glucose tolerance test identifies prediabetes risk.

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