目的:使用混合餐耐量试验(MMTT)确定2型糖尿病发病的预测因子。
方法:来自纵向队列的无糖尿病的成年土著美国人(n=501)在基线时接受4小时MMTT,身体成分的测量,口服葡萄糖耐量试验,急性胰岛素反应(AIR)的静脉葡萄糖耐量试验,和用于胰岛素作用的高胰岛素-正常血糖钳夹(M)。通过曲线下总面积和增量(AUC/iAUC)定量来自MMTT的血浆葡萄糖应答。
结果:随访时(中位时间9.6[四分位数范围:5.6-13.5]年),169名参与者被诊断为糖尿病。未调整的Cox比例风险模型,葡萄糖AUC180-min(HR:1.98,95%CI:1.67,2.34,p<0.0001),AUC240-min(HR:1.93,95%CI:1.62,2.31,p<0.0001),iAUC180-min(HR:1.43,95%CI:1.20,1.71,p<0.0001)与糖尿病风险增加相关。在调整协变量(年龄,性别,身体脂肪百分比,M,AIR,美国土著遗产)在随后的三个模型中,AUC180-min(HR:1.44,95%CI:1.10,1.88,p=0.007)和AUC240-min(HR:1.41,95%CI:1.09,1.84,p<0.01)与糖尿病风险增加相关。
结论:混合膳食的葡萄糖反应预测了2型糖尿病的发展。这表明混合营养挑战提供了有关疾病风险的重要信息。
背景:ClinicalTrials.gov标识符:NCT00340132,NCT00339482。
To identify predictors of incident type 2 diabetes using a mixed meal tolerance test (MMTT).
Adult Indigenous Americans without diabetes (n = 501) from a longitudinal cohort underwent at baseline a 4-h MMTT, measures of body composition, an oral glucose tolerance test, an intravenous glucose tolerance test for acute insulin response (AIR), and a hyperinsulinemic-euglycemic clamp for insulin action (M). Plasma glucose responses from the MMTT were quantified by the total and incremental area under the curve (AUC/iAUC).
At follow-up (median time 9.6 [inter-quartile range: 5.6-13.5] years), 169 participants were diagnosed with diabetes. Unadjusted Cox proportional hazards models, glucose AUC180-min (HR: 1.98, 95% CI: 1.67, 2.34, p < 0.0001), AUC240-min (HR: 1.93, 95% CI: 1.62, 2.31, p < 0.0001), and iAUC180-min (HR: 1.43, 95% CI: 1.20, 1.71, p < 0.0001) were associated with an increased risk of diabetes. After adjustment for covariates (age, sex, body fat percentage, M, AIR, Indigenous American heritage) in three subsequent models, AUC180-min (HR: 1.44, 95% CI: 1.10, 1.88, p = 0.007) and AUC240-min (HR: 1.41, 95% CI: 1.09, 1.84, p < 0.01) remained associated with increased risk of diabetes.
Glucose responses to a mixed meal predicted the development of type 2 diabetes. This indicates that a mixed nutritional challenge provides important information on disease risk.
ClinicalTrials.gov identifier : NCT00340132, NCT00339482.