Diabetes Metab J.  2020 Apr;44(2):286-294. 10.4093/dmj.2019.0016.

Glucose Effectiveness from Short Insulin-Modified IVGTT and Its Application to the Study of Women with Previous Gestational Diabetes Mellitus

• Morettini M
• Castriota C
• Göbl C
• Kautzky-Willer A
• Pacini G
• Burattini L
• Tura A

• KMID: 2502410
• DOI: http://doi.org/10.4093/dmj.2019.0016

Abstract

Background
This study aimed to design a simple surrogate marker (i.e., predictor) of the minimal model glucose effectiveness (SG), namely calculated SG (CSG), from a short insulin-modified intravenous glucose tolerance test (IM-IVGTT), and then to apply it to study women with previous gestational diabetes mellitus (pGDM).
Methods
CSG was designed using the stepwise model selection approach on a population of subjects (n=181) ranging from normal tolerance to type 2 diabetes mellitus (T2DM). CSG was then tested on a population of women with pGDM (n=57). Each subject underwent a 3-hour IM-IVGTT; women with pGDM were observed early postpartum and after a follow-up period of up to 7 years and classified as progressors (PROG) or non-progressors (NONPROG) to T2DM. The minimal model analysis provided a reference SG.
Results
CSG was described as CSG=1.06×10–2+5.71×10–2×KG/Gpeak, KG being the mean slope (absolute value) of loge glucose in 10–25- and 25–50-minute intervals, and Gpeak being the maximum of the glucose curve. Good agreement between CSG and SG in the general population and in the pGDM group, both at baseline and follow-up (even in PROG and NONPROG subgroups), was shown by the Bland-Altman plots (<5% observations outside limits of agreement), and by the test for equivalence (equivalence margin not higher than one standard deviation). At baseline, the PROG subgroup showed significantly lower SG and CSG values compared to the NONPROG subgroup (P<0.03).
Conclusion
CSG is a valid SG predictor. In the pGDM group, glucose effectiveness appeared to be impaired in women progressing to T2DM.

Keyword

Diabetes, gestational; Diabetes mellitus, type 2; Glucose metabolism disorders; Glucose tolerance test; Models, theoretical

Figure

• 

  Fig. 1 Bland-Altman plot for the training dataset (A) and the jackknife-based validation dataset (B) in a population of subjects with different clinical characteristics (nondiabetic [ND] and type 2 diabetes mellitus [T2DM] groups). The continuous line represents the mean of the difference between minimal model glucose effectiveness (SG) and calculated SG (CSG); the dash-dotted lines represent the limits of agreement (mean±1.96×standard deviation).

• 

  Fig. 2 Bland-Altman plot for the previous gestational diabetes mellitus group (women) at baseline (A) and follow-up (B). The continuous line represents the mean of the difference between minimal model glucose effectiveness (SG) and calculated SG (CSG); the dash-dotted lines represent the limits of agreement (mean±1.96×standard deviation).

• 

  Fig. 3 Bland-Altman plot for the (A) women not progressing to type 2 diabetes mellitus (NONPROG) and (B) women progressing to type 2 diabetes mellitus (PROG) subgroups at baseline and follow-up. The continuous line represents the mean of the difference between minimal model glucose effectiveness (SG) and calculated SG (CSG); the dash-dotted lines represent the limits of agreement (mean±1.96×standard deviation).

• 

  Fig. 4 Glucose effectiveness assessed by (A) minimal model glucose effectiveness (SG) and (B) calculated SG (CSG) at baseline and follow-up in the women not progressing to type 2 diabetes mellitus at follow-up (NONPROG) and women progressing to type 2 diabetes mellitus (PROG) subgroups. Data are expressed as mean±standard error of the mean. aStatistically significant difference (P<0.05).

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