Indices of Insulin Secretion during a Liquid Mixed-Meal Test in Obese Youth with Diabetes

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• 作者：Fida Bacha ; MD¹ ; ² ; ³ ; ^{fbacha@bcm.edu} ; Neslihan Gungor ; MD⁴ ; Sojung Lee ; PhD¹ ; Javier de las Heras ; MD⁵ ; Silva Arslanian ; MD¹ ; ²
• 关键词：¦¤C30/¦¤G30 ; C-peptide&ndash ; derived 30-minute index ; ¦¤I30/¦¤G30 ; Insulinogenic 30-minute index ; Ab ; Antibody ; AUC ; Area under the curve ; BMI ; Body mass index ; CF ; Fasting C-peptide ; GF ; Fasting glucose ; HbA1c ; Hemoglobin A1c ; HOMA- % ¦Â ; Homeostasis model
• 刊名：The Journal of Pediatrics
• 出版年：2013
• 出版时间：May, 2013
• 年：2013
• 卷：162
• 期：5
• 页码：924-929
• 全文大小：259 K

文摘

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Objective

To compare indices of insulin secretion, insulin sensitivity (IS), and oral disposition index (oDI) during the liquid mixed-meal test in obese youth with clinically diagnosed type 2 diabetes mellitus (T2DM) and negative autoantibodies (Ab^?) versus those with T2DM and positive autoantibodies (Ab⁺) to examine whether differences in ¦Â-cell function can be detected between the 2 groups.

Study design

Twenty-seven youth with Ab^? and 15 youth with Ab⁺ clinically diagnosed T2DM underwent a mixed-meal test (Boost; 55 % carbohydrate, 25 % protein, and 20 % fat). Fasting and mixed-meal-derived insulin and C-peptide indices of IS, secretion (30-minute insulinogenic [¦¤I₃₀/¦¤G₃₀] and C-peptide [¦¤C₃₀/¦¤G₃₀]), and oDI were calculated.

Results

Indices of insulin secretion were ¡«40 % -50 % lower in patients with Ab⁺ T2DM compared with those with Ab^? T2DM. After controlling for body mass index, ¦¤I₃₀/¦¤G₃₀, ¦¤C₃₀/¦¤G₃₀, C-peptide area under the curve (AUC)/glucose AUC, and insulin AUC/glucose AUC were significantly (P?<?.05) lower in the Ab⁺ group compared with the Ab^? group. Sensitivity indices were significantly higher in the Ab⁺ group. The oDI, 1/fasting insulin?¡Á?¦¤I₃₀/¦¤G₃₀ (0.04?¡À?0.02 vs 0.12?¡À?0.02 mg/dL^?1; P?=?.005), and 1/fasting C-peptide?¡Á?¦¤C₃₀/¦¤G₃₀ (0.02?¡À?0.009 vs 0.05?¡À?0.006 mg/dL^?1; P?=?.018) were lower in the Ab⁺ group. Receiver operating characteristic curve analyses revealed that fasting C-peptide <3.2 ng/mL had 87 % sensitivity and 74 % specificity and ¦¤C₃₀/¦¤G₃₀ <0.075 ng/mL per mg/dL had 93 % sensitivity and 80 % specificity for identifying youth with Ab⁺ T2DM.

Conclusion

During a liquid mixed-meal test, indices of ¦Â-cell function were lower and IS was higher in patients with Ab⁺ T2DM versus those with Ab^? T2DM, with high sensitivity and specificity for fasting and stimulated C-peptide as markers of Ab⁺ status. Indices of insulin secretion during this standardized mixed-meal test could be used to assess ¦Â-cell function in therapeutic trials of ¦Â-cell restoration in youth with T2DM.