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题名:Indices of insulin secretion during a liquid mixed-meal test in obese youth with diabetes.
作者:BACHA F; GUNGOR N; LEE S; DE LAS HERAS J; ARSLANIAN S;
来源:J Pediatr. 2013 May;162(5):924-9. doi: 10.1016/j.jpeds.2012.11.037. Epub 2013 Jan [ IF= 0.00 ] ]
URL :10.1016/j.jpeds.2012.11.037
日期:20130131
摘要: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 beta-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 [DeltaI(30)/DeltaG(30)] and
C-peptide [DeltaC(30)/DeltaG(30)]), 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,
DeltaI(30)/DeltaG(30), DeltaC(30)/DeltaG(30), 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 x
DeltaI(30)/DeltaG(30) (0.04 +/- 0.02 vs 0.12 +/- 0.02 mg/dL(-1); P = .005), and
1/fasting C-peptide x DeltaC(30)/DeltaG(30) (0.02 +/- 0.009 vs 0.05 +/- 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 DeltaC(30)/DeltaG(30) <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 beta-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 beta-cell function in therapeutic trials
of beta-cell restoration in youth with T2DM.

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