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- Title
The Shape of the Glucose Response Curve During an Oral Glucose Tolerance Test: Forerunner of Heightened Glycemic Failure Rates and Accelerated Decline in β-Cell Function in TODAY.
- Authors
Arslanian, Silva; ghormli, Laure El; Joon Young Kim; Bacha, Fida; Chan, Christine; Ismail, Heba M.; Levitt Katz, Lorraine E.; Levitsky, Lynne; Tryggestad, Jeanie B.; White, Neil H.; El Ghormli, Laure; Kim, Joon Young; TODAY Study Group; Young Kim, Joon
- Abstract
<bold>Objective: </bold>Obese 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.<bold>Research Design and Methods: </bold>OGTTs (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.<bold>Results: </bold>At 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.<bold>Conclusions: </bold>In 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.
- Subjects
GLUCOSE tolerance tests; GLYCEMIC control; CELL physiology; INSULIN resistance; BIPHASIC insulin
- Publication
Diabetes Care, 2019, Vol 42, Issue 1, p164
- ISSN
0149-5992
- Publication type
journal article
- DOI
10.2337/dc18-1122