Relationship between glycaemic variability and hyperglycaemic clamp-derived functional variables in (impending) type 1 diabetes
| Autor: | Johannes Ruige, Ilse Weets, Pieter Gillard, Frans Gorus, Belgian Diabetes Registry, An Walgraeve, Eric V. Balti, Simke Demeester, Daniel Pipeleers, Annelien Van Dalem, Bart Keymeulen, Evy Vandemeulebroucke, Ursule Van de Velde, Christophe De Block, Nicole Seret, Katelijn Decochez |
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| Přispěvatelé: | Pathologic Biochemistry and Physiology, Pathology/molecular and cellular medicine, Faculty of Medicine and Pharmacy, Internal Medicine Specializations, Public Health Sciences, Institute for Clinical Research, Diabetes Pathology & Therapy, Belgian Diabetes Registry |
| Rok vydání: | 2015 |
| Předmět: |
Adult
Blood Glucose Male medicine.medical_specialty Adolescent endocrine system diseases Endocrinology Diabetes and Metabolism medicine.medical_treatment Young Adult Insulin resistance Insulin-Secreting Cells Internal medicine Blood Glucose Self-Monitoring Diabetes mellitus Internal Medicine medicine Humans Prediabetes Child Glycated Hemoglobin Type 1 diabetes Glucose tolerance test C-Peptide medicine.diagnostic_test business.industry Insulin Glucose Tolerance Test Glucose clamp technique medicine.disease Healthy Volunteers Diabetes Mellitus Type 1 Endocrinology Area Under Curve Hyperglycemia Glucose Clamp Technique Cardiology Female Human medicine business |
| Zdroj: | Diabetologia |
| ISSN: | 1432-0428 0012-186X |
| DOI: | 10.1007/s00125-015-3761-y |
| Popis: | We examined whether measures of glycaemic variability (GV), assessed by continuous glucose monitoring (CGM) and self-monitoring of blood glucose (SMBG), can complement or replace measures of beta cell function and insulin action in detecting the progression of preclinical disease to type 1 diabetes. Twenty-two autoantibody-positive (autoAb+) first-degree relatives (FDRs) of patients with type 1 diabetes who were themselves at high 5-year risk (50%) for type 1 diabetes underwent CGM, a hyperglycaemic clamp test and OGTT, and were followed for up to 31 months. Clamp variables were used to estimate beta cell function (first-phase [AUC5–10 min] and second-phase [AUC120–150 min] C-peptide release) combined with insulin resistance (glucose disposal rate; M 120–150 min). Age-matched healthy volunteers (n = 20) and individuals with recent-onset type 1 diabetes (n = 9) served as control groups. In autoAb+ FDRs, M 120–150 min below the 10th percentile (P10) of controls achieved 86% diagnostic efficiency in discriminating between normoglycaemic FDRs and individuals with (impending) dysglycaemia. M 120–150 min outperformed AUC5–10 min and AUC120–150 min C-peptide below P10 of controls, which were only 59–68% effective. Among GV variables, CGM above the reference range was better at detecting (impending) dysglycaemia than elevated SMBG (77–82% vs 73% efficiency). Combined CGM measures were equally efficient as M 120–150 min (86%). Daytime GV variables were inversely correlated with clamp variables, and more strongly with M 120–150 min than with AUC5–10 min or AUC120–150 min C-peptide. CGM-derived GV and the glucose disposal rate, reflecting both insulin secretion and action, outperformed SMBG and first- or second-phase AUC C-peptide in identifying FDRs with (impending) dysglycaemia or diabetes. Our results indicate the feasibility of developing minimally invasive CGM-based criteria for close metabolic monitoring and as outcome measures in trials. |
| Databáze: | OpenAIRE |
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