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Title
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The ¹³C glucose breath test accurately identifies insulin resistance in people with type 1 diabetes
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Author
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Abstract
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| Objective This study investigated whether the delta-over-baseline of exhaled (CO2)-C-13 (Delta(CO2)-C-13), generated from a C-13 glucose breath test (13C-GBT), measured insulin resistance (IR) in people with type 1 diabetes, using the hyperinsulinemic-euglycemic clamp (HEC) as a reference method. The secondary objective was to compare the 13C-GBT with the estimated glucose disposal rate (eGDR). Methods A 40 mU/m(2)/min HEC and 2 separate 13C-GBTs (euglycemic with insulin bolus and hyperglycemic without bolus) were consecutively performed in 44 adults with type 1 diabetes with varying body compositions. eGDR was calculated based on hemoglobin A1c (HbA1c), presence of hypertension, and waist circumference. Results The mean glucose disposal rate (M-value) was 5.9 +/- 3.1 mg/kg/min and mean euglycemic Delta(CO2)-C-13 was 6.4 +/- 2.1 delta parts per thousand, while median eGDR was 5.9 [4.3-9.8] mg/kg/min. The hyperglycemic Delta(CO2)-C-13 did not correlate with the M-value, while the euglycemic Delta(CO2)-C-13 and the M-value correlated strongly (r = 0.74, P < .001). The correlation between M-value and eGDR was more moderate (Spearman's rho = 0.63, P < .001). Linear regression showed an association between Delta(CO2)-C-13 and M-value, adjusted for age, sex, and HbA1c ]adjusted R-2 = 0.52, B = 1.16, 95% confidence interval (CI) .80-1.52, P < .001]. The area under the receiver-operator characteristics curve for Delta(CO2)-C-13 to identify subjects with IR (M-value < 4.9 mg/kg/min) was 0.81 (95% CI .68-.94, P < .001). The optimal cut-off for Delta(CO2)-C-13 to identify subjects with IR was <= 5.8 delta parts per thousand. Conclusion Under euglycemic conditions, the 13C-GBT accurately identified individuals with type 1 diabetes and concurrent IR, suggesting its potential as a valuable noninvasive index. |
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Language
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English
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Source (journal)
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The journal of clinical endocrinology and metabolism. - Baltimore, Md
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Publication
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Washington
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Endocrine soc
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2024
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ISSN
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0021-972X
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DOI
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10.1210/CLINEM/DGAE175
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Volume/pages
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(2024)
, p. 1-11
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ISI
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001193732200001
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Pubmed ID
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38487831
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Full text (Publisher's DOI)
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Full text (publisher's version - intranet only)
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