J Obes Metab Syndr.  2021 Jun;30(2):178-183. 10.7570/jomes20088.

The Shape of the Oral Glucose Tolerance Test-Glucose Response Curve in Islet Cell Antibody-Positive vs. -Negative Obese Youth Clinically Diagnosed with Type 2 Diabetes

Affiliations
  • 1Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, New York, NY, USA
  • 2Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
  • 3Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
  • 4Center for Pediatric Research in Obesity and Metabolism, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
  • 5Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

Abstract

Background
The oral glucose tolerance test (OGTT)-glucose response curves (GRCs; incessant increase, monophasic, and biphasic) reflect insulin sensitivity and β-cell function, being worse in the former and superior in the latter. Here, we examined if the OGTT-GRC pattern is worse in obese antibody (glutamic acid decarboxylase 65-kDa [GAD65] and insulinoma-associated protein-2 [IA-2])-positive (Ab+) vs. –negative (Ab) youth clinically diagnosed with type 2 diabetes (CDX-T2D).
Methods
Forty-seven obese youth, 15 Ab+ and 32 Ab , were divided into three OGTT-GRC groups: incessant increase, monophasic, and biphasic. The prevalence of OGTT-GRC, clamp-measured insulin sensitivity, and β-cell function was compared.
Results
Incessant increase OGTT-GRC is the most frequent curve type and is three-fold higher in Ab+ vs. Ab youth CDX-T2D. In Ab+ youth, there was up to 40% lower second-phase insulin secretion in the incessant increase group vs. the other two groups combined (monophasic and biphasic). In Ab youth, while first- and second-phase insulin secretion was significantly lower in the incessant increase vs. the other two groups combined, overall β-cell function was less impaired than in Ab+ youth. In neither Ab or Ab+ youth was OGTT-GRC related to hepatic or peripheral insulin sensitivity.
Conclusion
Severe insulin deficiency, a characteristic of type 1 diabetes, seems to be related to higher prevalence of incessant increase in Ab+ vs. Ab obese youth.

Keyword

Oral glucose tolerance test; Glucose intolerance; Insulin resistance; Insulin secretion; Type 2 diabetes mellitus; Obesity; Adolescent
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