背景:在这篇系统综述中,我们调查了基于空腹样本和口服葡萄糖耐量试验(OGTT)的胰岛素分泌替代措施的诊断准确性.使用两种金标准方法计算胰岛素分泌的第一阶段;高血糖钳夹(HGC)测试和静脉葡萄糖耐量测试(IVGTT)。
方法:我们在PubMed中进行了搜索,CochraneCentral,和WebofScience数据库,最后一次是在2021年6月底进行的。研究包括使用金标准参考方法(HGC或IVGTT)和一个或多个空腹样本的替代措施来测量成人的第一阶段胰岛素分泌。OGTT或膳食耐受性测试。QUADAS-2,用于诊断准确性研究质量评估的修订工具,用于质量评估。进行了随机效应荟萃分析,以检查用金标准和替代方法测量的第一阶段之间的相关性。
结果:共33篇,包括5362名糖耐量正常的个体,糖尿病前期或2型糖尿病,包括在我们的系统审查中。稳态模型评估(HOMA)-β和胰岛素发生指数30(IGI(30))是在最多数量的研究中验证的替代措施(分别为17和13)。HOMA-β与参考方法的合并相关性为0.48(95%CI0.40至0.56),IGI与参考方法的合并相关性为0.61(95%CI0.54至0.68)。与参考方法相关性最高的替代指标是Kadowaki(0.67(95%CI0.61至0.73))和Stumvoll的第一阶段分泌(0.65(95%CI0.58至0.71)),两者都是从OGTT计算的。
结论:从OGTT捕获胰岛素分泌的第一阶段开始的前30分钟的替代措施是流行病学研究的好选择。HOMA-β与参考方法具有中等相关性,但不是第一阶段的特异性量度。
■在开始纳入之前,荟萃分析在PROSPERO(ID:CRD42020169064)注册。
BACKGROUND: In this systematic review, we investigated the diagnostic accuracy of surrogate measures of insulin secretion based on fasting samples and the oral glucose tolerance test (OGTT). The first phase of insulin secretion was calculated using two gold standard methods; the hyperglycemic clamp (HGC) test and intravenous glucose tolerance test (IVGTT).
METHODS: We conducted searches in the PubMed, Cochrane Central, and Web of Science databases, the last of which was conducted at the end of June 2021. Studies were included that measured first-phase insulin secretion in adults using both a gold-standard reference method (either HGC or IVGTT) and one or more surrogate measures from either fasting samples, OGTT or a meal-tolerance test. QUADAS-2, a revised tool for the quality assessment of diagnostic accuracy studies, was used for quality assessment. Random-effects meta-analyses were performed to examine the correlation between first-phase measured with gold standard and surrogate methods.
RESULTS: A total of 33 articles, encompassing 5362 individuals with normal glucose tolerance, pre-diabetes or type 2 diabetes, were included in our systematic review. Homeostatic model assessment (HOMA)-beta and Insulinogenic Index 30 (IGI(30)) were the surrogate measures validated in the largest number of studies (17 and 13, respectively). HOMA-beta\'s pooled correlation to the reference methods was 0.48 (95% CI 0.40 to 0.56) The pooled correlation of IGI to the reference methods was 0.61 (95% CI 0.54 to 0.68). The surrogate measures with the highest correlation to the reference methods were Kadowaki (0.67 (95% CI 0.61 to 0.73)) and Stumvoll\'s first-phase secretion (0.65 (95% CI 0.58 to 0.71)), both calculated from an OGTT.
CONCLUSIONS: Surrogate measures from the first 30 min of an OGTT capture the first phase of insulin secretion and are a good choice for epidemiological studies. HOMA-beta has a moderate correlation to the reference methods but is not a measure of the first phase specifically.
UNASSIGNED: The meta-analysis was registered at PROSPERO (Id: CRD42020169064) before inclusion started.