Normal Meal Tolerance Test is Preferable to the Glucagon Stimulation Test in Patients with Type 2 Diabetes That Are Not in a Hyperglycemic State: Comparison with the Change of C-peptide Immunoreactivity

Overview

Journal J Diabetes Investig

Specialty Endocrinology

Date 2017 May 12

PMID 28494143

Citations 10

Authors

Youhei Fujioka

Tsuyoshi Okura

Keisuke Sumi

Kazuhisa Matsumoto

Kyoko Shoji

Risa Nakamura

Kazuhiko Matsuzawa

Shoichiro Izawa

Masahiko Kato

Shinichi Taniguchi

Kazuhiro Yamamoto

Affiliations

Soon will be listed here.

Abstract

Aims/introduction: The aim of the present study was to evaluate the properties of the glucagon stimulation test (GST) and the normal meal tolerance test (NMTT) in patients with type 2 diabetes.

Materials And Methods: We enrolled 142 patients with type 2 diabetes, and carried out a GST and a NMTT. We carried out the NMTT using a calorie-controlled meal based on an intake of 30 kcal/kg ideal bodyweight/day. We calculated the change in C-peptide immunoreactivity (ΔCPR) by subtracting fasting CPR from the CPR 6 min after the 1-mg glucagon injection (GST) or 120 min after the meal (NMTT).

Results: Mean ΔCPR for the GST was 2.0 ng/mL, and for the NMTT was 3.1 ng/mL. A total of 104 patients had greater ΔCPR in the NMTT than the GST, and the mean ΔCPR was significantly greater in the NMTT than the GST (P < 0.05). To exclude any influence of antidiabetic drugs, we examined 42 individuals not taking antidiabetic agents, and found the mean ΔCPR was significantly greater in the NMTT than the GST (GST 2.4 ng/mL, NMTT 4.3 ng/mL; P < 0.05). To consider the influence of glucose toxicity, we carried out receiver operating characteristic analyses with fasting plasma glucose and glycated hemoglobin. The optimal cut-off levels predicting GST ΔCPR to be larger than NMTT ΔCPR were fasting plasma glucose 147 mg/dL and glycated hemoglobin 9.0% (fasting plasma glucose: sensitivity 0.64, specificity 0.76, area under the curve 0.73; glycated hemoglobin: sensitivity 0.56, specificity 0.71, area under the curve 0.66).

Conclusions: The NMTT is a reliable insulin secretion test in patients with type 2 diabetes, except for those in a hyperglycemic state.

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References

Youden W . Index for rating diagnostic tests. Cancer. 1950; 3(1):32-5. DOI: 10.1002/1097-0142(1950)3:1<32::aid-cncr2820030106>3.0.co;2-3. View

Besser R, Jones A, McDonald T, Shields B, Knight B, Hattersley A . The impact of insulin administration during the mixed meal tolerance test. Diabet Med. 2012; 29(10):1279-84. DOI: 10.1111/j.1464-5491.2012.03649.x. View

Kashiwagi A, Kasuga M, Araki E, Oka Y, Hanafusa T, Ito H . International clinical harmonization of glycated hemoglobin in Japan: From Japan Diabetes Society to National Glycohemoglobin Standardization Program values. J Diabetes Investig. 2014; 3(1):39-40. PMC: 4014931. DOI: 10.1111/j.2040-1124.2012.00207.x. View

Palmer J, Fleming G, Greenbaum C, Herold K, Jansa L, Kolb H . C-peptide is the appropriate outcome measure for type 1 diabetes clinical trials to preserve beta-cell function: report of an ADA workshop, 21-22 October 2001. Diabetes. 2003; 53(1):250-64. DOI: 10.2337/diabetes.53.1.250. View

Rossetti L, Giaccari A, DeFronzo R . Glucose toxicity. Diabetes Care. 1990; 13(6):610-30. DOI: 10.2337/diacare.13.6.610. View

Funakoshi S, Fujimoto S, Hamasaki A, Fujiwara H, Fujita Y, Ikeda K . Analysis of factors influencing postprandial C-peptide levels in Japanese patients with type 2 diabetes: Comparison with C-peptide levels after glucagon load. J Diabetes Investig. 2014; 2(6):429-34. PMC: 4014901. DOI: 10.1111/j.2040-1124.2011.00126.x. View

Meier J, Pennartz C, Schenker N, Menge B, Schmidt W, Heise T . Hyperglycaemia is associated with impaired pulsatile insulin secretion: effect of basal insulin therapy. Diabetes Obes Metab. 2012; 15(3):258-63. DOI: 10.1111/dom.12022. View

Greenbaum C, Mandrup-Poulsen T, McGee P, Battelino T, Haastert B, Ludvigsson J . Mixed-meal tolerance test versus glucagon stimulation test for the assessment of beta-cell function in therapeutic trials in type 1 diabetes. Diabetes Care. 2008; 31(10):1966-71. PMC: 2551636. DOI: 10.2337/dc07-2451. View

. Effect of intensive therapy on residual beta-cell function in patients with type 1 diabetes in the diabetes control and complications trial. A randomized, controlled trial. The Diabetes Control and Complications Trial Research Group. Ann Intern Med. 1998; 128(7):517-23. DOI: 10.7326/0003-4819-128-7-199804010-00001. View

10.

. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010; 33 Suppl 1:S62-9. PMC: 2797383. DOI: 10.2337/dc10-S062. View

11.

DeFronzo R . Lilly lecture 1987. The triumvirate: beta-cell, muscle, liver. A collusion responsible for NIDDM. Diabetes. 1988; 37(6):667-87. DOI: 10.2337/diab.37.6.667. View

12.

. U.K. prospective diabetes study 16. Overview of 6 years' therapy of type II diabetes: a progressive disease. U.K. Prospective Diabetes Study Group. Diabetes. 1995; 44(11):1249-58. View

13.

Perkins N, Schisterman E . The inconsistency of "optimal" cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol. 2006; 163(7):670-5. PMC: 1444894. DOI: 10.1093/aje/kwj063. View

14.

Daneman D, Clarson C . Residual beta-cell function in children with type 1 diabetes: measurement and impact on glycemic control. Clin Invest Med. 1987; 10(5):484-7. View

15.

Fujioka Y, Okura T, Sumi K, Matsumoto K, Shoji K, Nakamura R . Normal meal tolerance test is preferable to the glucagon stimulation test in patients with type 2 diabetes that are not in a hyperglycemic state: Comparison with the change of C-peptide immunoreactivity. J Diabetes Investig. 2017; 9(2):274-278. PMC: 5835464. DOI: 10.1111/jdi.12692. View

16.

Albarrak A, Luzio S, Chassin L, Playle R, Owens D, Hovorka R . Associations of glucose control with insulin sensitivity and pancreatic beta-cell responsiveness in newly presenting type 2 diabetes. J Clin Endocrinol Metab. 2002; 87(1):198-203. DOI: 10.1210/jcem.87.1.8152. View

17.

Faber O, Binder C . C-peptide response to glucagon. A test for the residual beta-cell function in diabetes mellitus. Diabetes. 1977; 26(7):605-10. DOI: 10.2337/diab.26.7.605. View