Dataset Information

Mixed-meal tolerance test to assess residual beta-cell secretion: Beyond the area-under-curve of plasma C-peptide concentration.

ABSTRACT:

Aims

Residual beta-cell secretion in type 1 diabetes is commonly assessed by area-under-curve of plasma C-peptide concentration (AUC_Cpep ) following mixed-meal tolerance test (MMTT). We aimed to investigate alternative measures of beta-cell responsiveness.

Methods

We analyzed data from 32 youth (age 7 to 17 years) undergoing MMTT within 6 months of type 1 diabetes diagnosis. We related AUC_Cpep with (a) validated mechanistic index of postprandial beta-cell responsiveness M_I accounting for glucose level during MMTT, and (b) pragmatic marker calculated as baseline plasma C-peptide concentration corrected for baseline plasma glucose concentration.

Results

Postprandial responsiveness M_I was correlated with age and BMI SDS (R_s = 0.66 and 0.44, P < 0.01 and P < 0.05) and was more correlated with glycated hemoglobin than AUC_Cpep (R_s = 0.79, P = 0.04). The pragmatic marker was highly correlated with AUC_Cpep (R_s = 0.94, P < 0.01).

Conclusions

Postprandial responsiveness M_I may be more relevant to glucose control than AUC_Cpep . Baseline C-peptide corrected for baseline glucose appears to be a suitable surrogate of AUC_Cpep if MMTT is not performed.

SUBMITTER: Ruan Y

PROVIDER: S-EPMC6487945 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Publications

Mixed-meal tolerance test to assess residual beta-cell secretion: Beyond the area-under-curve of plasma C-peptide concentration.

Ruan Yue Y Willemsen Ruben H RH Wilinska Malgorzata E ME Tauschmann Martin M Dunger David B DB Hovorka Roman R

Pediatric diabetes 20190219 3

<h4>Aims</h4>Residual beta-cell secretion in type 1 diabetes is commonly assessed by area-under-curve of plasma C-peptide concentration (AUC<sub>Cpep</sub> ) following mixed-meal tolerance test (MMTT). We aimed to investigate alternative measures of beta-cell responsiveness.<h4>Methods</h4>We analyzed data from 32 youth (age 7 to 17 years) undergoing MMTT within 6 months of type 1 diabetes diagnosis. We related AUC<sub>Cpep</sub> with (a) validated mechanistic index of postprandial beta-cell res ...[more]

PMID: 30652426

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Project description:AIM:To develop a vancomycin population pharmacokinetic model and assess the probability of attaining a pharmacodynamic target associated with clinical and microbiological success, a ratio of the 24-hour area under the concentration-time curve to the minimum inhibitory concentration (MIC) ? 400, in a 5-year clinical cohort of preterm and term neonatal patients with late-onset staphylococcal sepsis. METHODS:Therapeutic drug monitoring data were obtained from septic neonates with ?1 vancomycin concentration(s) from January 2006 to September 2011. Only neonates with a postnatal age of >72 hours and a positive microbiological culture were included. Population pharmacokinetic model was developed using nonlinear mixed effects modeling (NONMEM 7.2). Eleven demographic characteristics were evaluated as covariates. Probabilities of achieving the pharmacodynamic target were evaluated. RESULTS:A 1-compartment model with first-order elimination was constructed from 528 vancomycin concentrations collected from 152 preterm and term neonates. Body weight, creatinine clearance (CL), and postmenstrual age were identified as significant covariates. Estimated vancomycin CL and volume of distribution for typical neonates were 0.068 ± 0.03 L·h·kg and 0.62 ± 0.13 L/kg, respectively. Coagulase-negative staphylococci (85.5%) and Staphylococcus aureus (14.5%) were the common pathogenic organisms. The distribution of vancomycin MIC breakpoints was composed of approximately 70% MIC breakpoint of ?2 mcg/mL. Approximately 54% of neonates, with a median serum creatinine concentration of 0.44 mg/dL, achieved the target ratio of 24-hour area under the concentration-time curve to the MIC ? 400 with a median daily dose of 30 (interquartile range, 21-42) mg/kg. CONCLUSIONS:Body weight, creatinine CL, and postmenstrual age significantly influenced vancomycin CL. The current vancomycin doses are acceptable at MICs ?1 mcg/mL because they are likely to achieve the pharmacodynamic target in the majority of neonatal patients, although higher doses may be considered for more resistant staphylococcal infections.

Dataset Information

Mixed-meal tolerance test to assess residual beta-cell secretion: Beyond the area-under-curve of plasma C-peptide concentration.

Aims

Methods

Results

Conclusions

Publications

Mixed-meal tolerance test to assess residual beta-cell secretion: Beyond the area-under-curve of plasma C-peptide concentration.

Similar Datasets

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