β-Cell Function and Insulin Sensitivity in Youth With Early Type 1 Diabetes From a 2-Hour 7-Sample OGTT
β-Cell Function and Insulin Sensitivity in Youth With Early Type 1 Diabetes From a 2-Hour 7-Sample OGTT
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DOI：
10.1210/clinem/dgac740
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发表时间：
2022-12-21
影响因子：
5.8
通讯作者：
Moran, Antoinette
中科院分区：
文献类型：
--
作者：
Galderisi, Alfonso;Evans-Molina, Carmella;Moran, Antoinette
内容：口服最小模型是一种广泛接受的非侵入性工具，用于在3小时9点口服葡萄糖耐量试验（OGTT）期间根据葡萄糖、C肽和胰岛素浓度定量β细胞反应性和胰岛素敏感性（SI）。目的：在这里，我们的目的是验证一个2小时的7点协议对3小时OGTT和测试早期采样频率的变化如何影响β细胞反应性和SI的估计。研究方法：我们对15名患有1期1型糖尿病（T1 D; >= 2个胰岛自身抗体，无功能障碍）的消瘦青年进行了二次分析，他们接受了3小时9点OGTT。口服最小模型用于定量β细胞反应性（phi（总））和胰岛素敏感性（SI），允许通过处置指数（DI = phi（总）x SI）评估β细胞功能。7点和5点2小时OGTT方案进行了测试，对3小时9点金标准，以确定在不同的采样策略之间的phi（总）及其动态和静态组件，SI和DI的估计之间的协议。结果如下：处置指数的2小时估计值与3小时测量值显示出强相关性（r = 0.975; P < .001），β细胞反应性和SI的结果相似（分别为r = 0.997和r = 0.982; P < .001）。7点2小时和9点3小时方案之间3个估计值的一致性在Bland-Altman网格的95% CI内，DI、phi（总）和SI的中位差异分别为16.9%（-35.3至32.5）、0.2%（-0.6至1.3）和14.9%（-1.4至28.3）。相反，5点方案未提供phi动态和静态分量的可靠估计。结论：2小时7点OGTT在1期T1 D患者中用于评估β细胞反应性、SI和DI是可靠的。将这些分析纳入目前的2小时糖尿病分期和OGTT监测中，有可能更准确地量化T1 D早期阶段的进展风险。
Context: The oral minimal model is a widely accepted noninvasive tool to quantify both beta-cell responsiveness and insulin sensitivity (SI) from glucose, C-peptide, and insulin concentrations during a 3-hour 9-point oral glucose tolerance test (OGTT). Objective: Here, we aimed to validate a 2-hour 7-point protocol against the 3-hour OGTT and to test how variation in early sampling frequency impacts estimates of beta-cell responsiveness and SI. Methods: We conducted a secondary analysis on 15 lean youth with stage 1 type 1 diabetes (T1D; >= 2 islet autoantibodies with no dysglycemia) who underwent a 3-hour 9-point OGTT. The oral minimal model was used to quantitate beta-cell responsiveness (phi(total)) and insulin sensitivity (SI), allowing assessment of beta-cell function by the disposition index (DI = phi(total) x SI). Seven- and 5-point 2-hour OGTT protocols were tested against the 3-hour 9-point gold standard to determine agreement between estimates of phi(total) and its dynamic and static components, SI, and DI across different sampling strategies. Results: The 2-hour estimates for the disposition index exhibited a strong correlation with 3-hour measures (r = 0.975; P < .001) with similar results for beta-cell responsiveness and SI (r = 0.997 and r = 0.982; P < .001, respectively). The agreement of the 3 estimates between the 7-point 2-hour and 9-point 3-hour protocols fell within the 95% CI on the Bland-Altman grid with a median difference of 16.9% (-35.3 to 32.5), 0.2% (-0.6 to 1.3), and 14.9% (-1.4 to 28.3) for DI, phi(total), and SI. Conversely, the 5-point protocol did not provide reliable estimates of phi dynamic and static components. Conclusion: The 2-hour 7-point OGTT is reliable in individuals with stage 1 T1D for assessment of beta-cell responsiveness, SI, and DI. Incorporation of these analyses into current 2-hour diabetes staging and monitoring OGTTs offers the potential to more accurately quantify risk of progression in the early stages of T1D.