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Distinct metabolic profile according to the shape of the oral glucose tolerance test curve is related to whole glucose excursion: a cross-sectional study.

ABSTRACT: BACKGROUND:The shapes of the plasma glucose concentration curve during the oral glucose tolerance test are related to different metabolic risk profiles and future risk of type 2 DM. We sought to further analyze the relationship between the specific shapes and hyperglycemic states, the metabolic syndrome and hormones involved in carbohydrate and lipid metabolism, and to isolate the effect of the shape by adjusting for the area under the glucose curve. METHODS:One hundred twenty one adult participants underwent a 2-h oral glucose tolerance test and were assigned to either the monophasic (n?=?97) or the biphasic (n?=?24) group based upon the rise and fall of their plasma glucose concentration. We evaluated anthropometric measures, blood pressure, lipid profile, high-sensitivity C-reactive protein, glycated hemoglobin, insulin sensitivity, beta-cell function, C-peptide, glucagon, adiponectin and pancreatic polypeptide. RESULTS:Subjects with monophasic curves had higher fasting and 2-h plasma glucose levels, while presenting lower insulin sensitivity, beta-cell function, HDL cholesterol, adiponectin and pancreatic polypeptide levels. Prediabetes and metabolic syndrome had a higher prevalence in this group. Glycated hemoglobin, total cholesterol, triglycerides, high-sensitivity C-reactive protein and glucagon were not significantly different between groups. After adjusting for the area under the glucose curve, only the differences in the 1-h and 2-h plasma glucose concentrations and HDL cholesterol levels between the monophasic and biphasic groups remained statistically significant. CONCLUSIONS:Rates and intensity of metabolic dysfunction are higher in subjects with monophasic curves, who have lower insulin sensitivity and beta-cell function and a higher prevalence of prediabetes and metabolic syndrome. These differences, however, seem to be dependent on the area under the glucose curve.

SUBMITTER: de Andrade Mesquita L

PROVIDER: S-EPMC6097323 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Distinct metabolic profile according to the shape of the oral glucose tolerance test curve is related to whole glucose excursion: a cross-sectional study.

de Andrade Mesquita Leonardo L Pavan Antoniolli Luciana L Cittolin-Santos Giordano Fabricio GF Gerchman Fernando F

BMC endocrine disorders 20180816 1

<h4>Background</h4>The shapes of the plasma glucose concentration curve during the oral glucose tolerance test are related to different metabolic risk profiles and future risk of type 2 DM. We sought to further analyze the relationship between the specific shapes and hyperglycemic states, the metabolic syndrome and hormones involved in carbohydrate and lipid metabolism, and to isolate the effect of the shape by adjusting for the area under the glucose curve.<h4>Methods</h4>One hundred twenty one ...[more]

PMID: 30115058

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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.

Project description:ObjectiveObese youth without diabetes with monophasic oral glucose tolerance test (OGTT) glucose response curves have lower insulin sensitivity and impaired β-cell function compared with those with biphasic curves. The OGTT glucose response curve has not been studied in youth-onset type 2 diabetes. Here we test the hypothesis that the OGTT glucose response curve at randomization in youth in the TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth) study forecasts heightened glycemic failure rates and accelerated decline in β-cell function.Research design and methodsOGTTs (n = 662) performed at randomization were categorized as monophasic, biphasic, or incessant increase. Demographics, insulin sensitivity (1/fasting insulin), C-peptide index (△C30/△G30), and β-cell function relative to insulin sensitivity (oral disposition index [oDI]) were compared among the three groups.ResultsAt randomization, 21.7% had incessant increase, 68.6% monophasic, and 9.7% biphasic glucose response curves. The incessant increase group had similar insulin sensitivity but significantly lower C-peptide index and lower oDI, despite similar diabetes duration, compared with the other two groups. Glycemic failure rates were higher in the incessant increase group (58.3%) versus the monophasic group (42.3%) versus the biphasic group (39.1%) (P < 0.0001). The 6-month decline in C-peptide index (32.8% vs. 18.1% vs. 13.2%) and oDI (32.2% vs. 11.6% vs. 9.1%) was greatest in incessant increase versus monophasic and biphasic with no difference in insulin sensitivity.ConclusionsIn the TODAY study cohort, an incessant increase in the OGTT glucose response curve at randomization reflects reduced β-cell function and foretells increased glycemic failure rates with accelerated deterioration in β-cell function independent of diabetes duration and treatment assignment compared with monophasic and biphasic curves. The shape of the OGTT glucose response curve could be a metabolic biomarker prognosticating the response to therapy in youth with type 2 diabetes.

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Distinct metabolic profile according to the shape of the oral glucose tolerance test curve is related to whole glucose excursion: a cross-sectional study.

Publications

Distinct metabolic profile according to the shape of the oral glucose tolerance test curve is related to whole glucose excursion: a cross-sectional study.

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