Comparison of tests of B-cell function across a range of glucose tolerance from normal to diabetes
Comparison of tests of B-cell function across a range of glucose tolerance from normal to diabetes
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DOI：
10.2337/diabetes.48.9.1779
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发表时间：
1999-09-01
期刊：
影响因子：
7.7
通讯作者：
Turner, RC
中科院分区：
文献类型：
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作者：
Hermans, MP;Levy, JC;Turner, RC
目前还没有对β细胞功能的不同检测方法的相对性能进行充分比较。我们比较了7名正常葡萄糖耐量（NGT）受试者、8名糖耐量受损（IGT）受试者和9名2型糖尿病受试者在一系列葡萄糖耐量范围内常用的β细胞功能体内试验的区分。以随机顺序，每名受试者接受以下每种测试中的两项：1）频繁采样的0.3-g/kg静脉葡萄糖耐量测试（FSIVGTT），采用MinMod分析; 2）稳态模型评估（CHOMA），采用包含免疫反应性或特异性胰岛素测量的模型，以5分钟间隔从三个样本中进行; 3）连续输注180 mg。min（-1）。m（-2）葡萄糖，在50、55和60 min（1-h CIGMA）和110、115和120 min（2-h CIGMA）时对三个样本进行模型评估（CIGMA）。通过受试者内SD与潜在受试者间SD的比值（判别比（DR））评估每个测试的区分度。使用Pearson相关系数评估测试测量相同生理变量的程度，该相关系数针对由于测试不精确而导致的衰减进行了调整。考虑到两种试验的不精密度，使用无偏等效线比较结果。从HOMA评估的β-细胞功能和从CIGMA评估的β-细胞功能（CIGMA% β）（使用免疫反应性胰岛素）具有比第一时相静脉内葡萄糖耐量试验衍生的增量胰岛素峰、面积、胰岛素-葡萄糖指数和从FSIVGTT-MinMod评估的对葡萄糖的急性胰岛素反应更高的DR。CIGMA% β（免疫反应性胰岛素）具有最高的DR。FSIVGTT衍生的第一时相胰岛素反应试验与BOMA和CIGMA仅中度相关。使用特异性而非免疫反应性胰岛素进行HOMA和CIGMA并不能提高辨别力。使用免疫反应性胰岛素的简单测试如HOMA和CIGMA，在NGT、IGT和2型糖尿病受试者中提供了比FSIVGTT第一时相胰岛素反应测量更好的β细胞功能区分。
Adequate comparisons of the relative performance of different tests of beta-cell function are not available. We compared discrimination of commonly used in vivo tests of beta-cell function across a range of glucose tolerance in seven subjects with normal glucose tolerance (NGT), eight subjects with impaired glucose tolerance (IGT), and nine subjects with type 2 diabetes. In random order, each subject underwent two of each of the following tests: 1) frequently sampled 0.3-g/kg intravenous glucose tolerance test (FSIVGTT) with MinMod analysis; 2) homeostasis model assessment CHOMA) from three samples at 5-min intervals with a model incorporating immunoreactive or specific insulin measurements; and 3) continuous infusion of 180 mg . min(-1) . m(-2) glucose with model assessment (CIGMA) of three samples at 50, 55, and 60 min(1-h CIGMA) and at 110, 115, and 120 min (2-h CIGMA). The discrimination of each test was assessed by the ratio of the within-subject SD to the underlying between-subject SD, the discriminant ratio (DR). The degree to which tests measured the same physiological variable was assessed using Pearson's correlation coefficient adjusted for attenuation due to test imprecision. An unbiased line of equivalence, taking into account the imprecision of both tests, was used to compare results. beta-Cell function assessed from HOMA and beta-cell function assessed from CIGMA (CIGMA%beta) (using immunoreactive insulin) had higher DRs than first-phase intravenous glucose tolerance test-derived incremental insulin peak, area, insulin-to-glucose index, and acute insulin response to glucose from FSIVGTT-MinMod. CIGMA%beta (immunoreactive insulin) had the highest DR. FSIVGTT-derived first-phase insulin response tests correlated only moderately with BOMA and CIGMA. Using specific rather than immunoreactive insulin for HOMA and CIGMA did not improve discriminatory power. Simple tests such as HOMA and CIGMA, using immunoreactive insulin, offer better beta-cell function discrimination across subjects with NGT, IGT, and type 2 diabetes than measurements derived from FSIVGTT first-phase insulin response.