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. 2017 Mar;60(3):432-441.
doi: 10.1007/s00125-016-4165-3. Epub 2016 Dec 8.

Discriminatory ability of simple OGTT-based beta cell function indices for prediction of prediabetes and type 2 diabetes: the CODAM study

Louise J C J den Biggelaar  1   2 , Simone J S Sep  3   4 , Simone J P M Eussen  5   3   6 , Andrea Mari  7 , Ele Ferrannini  8 , Marleen M J van Greevenbroek  3   4 , Carla J H van der Kallen  3   4 , Casper G Schalkwijk  3   4 , Coen D A Stehouwer  3   4 , Pieter C Dagnelie  5   3   6
Affiliations

Discriminatory ability of simple OGTT-based beta cell function indices for prediction of prediabetes and type 2 diabetes: the CODAM study

Louise J C J den Biggelaar et al. Diabetologia. 2017 Mar.

Abstract

Aims/hypothesis: The hyperglycaemic clamp technique and the frequently sampled IVGTT are unsuitable techniques to assess beta cell function (BCF) in large cohorts. Therefore, the aim of this study was to evaluate the discriminatory ability of simple OGTT-based BCF indices for prediction of prediabetes (meaning impaired fasting glucose and/or impaired glucose tolerance) and type 2 diabetes.

Methods: Glucose metabolism status was assessed by 2 h 75 g OGTT at baseline (n = 476, mean age 59.2 years, 38.7% women) and after 7 years of follow-up (n = 416) in the Cohort on Diabetes and Atherosclerosis Maastricht (CODAM) study (1999-2009). Baseline plasma glucose, insulin and C-peptide values during OGTTs were used to calculate 21 simple indices of BCF. Disposition indices (BCF index × Matsuda index), to compensate for the prevailing level of insulin resistance, were calculated for the BCF indices with the best discriminatory abilities. The discriminatory ability of the BCF indices was estimated by the area under the receiver operating characteristics curve (ROC AUC) with an outcome of incident prediabetes (n = 73) or type 2 diabetes (n = 60 and n = 18 cases, respectively, in individuals who were non-diabetic or had normal glucose metabolism at baseline).

Results: For incident prediabetes (n = 73), all ROC AUCs were less than 70%, whereas for incident type 2 diabetes, I30/I0, CP30/CP0, ΔI30/ΔG30, ΔCP30/ΔG30 (where I, CP and G are the plasma concentrations of insulin, C-peptide and glucose, respectively, at the times indicated), and corrected insulin response at 30 min had ROC AUCs over 70%. In at-baseline non-diabetic individuals, disposition indices ΔI30/ΔG30, ΔCP30/ΔG30 and corrected insulin response at 30 min had ROC AUCs of over 80% for incident type 2 diabetes. Moreover, these BCF disposition indices had significantly better discriminatory abilities for incident type 2 diabetes than the Matsuda index alone.

Conclusions/interpretation: BCF indices reflecting early-phase insulin secretion have the best ability to discriminate individuals who will develop prediabetes and type 2 diabetes. Of these, ΔCP30/ΔG30, often referred to as the C-peptidogenic index, performed consistently well.

Keywords: Beta cell function; Discrimination; Indices; Insulin secretion; OGTT; Prediabetes; Receiver operating characteristics; Type 2 diabetes mellitus.

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Conflict of interest statement

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

LJCJdB and SJSS performed mathematical model analyses and statistical analyses, interpreted the data and wrote the manuscript. SJPME and PCD contributed to the conception and interpretation of the data and to data analyses, and participated in drafting the article and critically revising it for important intellectual content. AM and EF designed the mathematical model, provided support in performing mathematical analyses, contributed to the data quality of the mathematical analyses and made important contributions to the interpretation of the BCF data. MMJvG, CGS and CJHvdK contributed to data acquisition and study coordination. CDAS provided advice and contributed to the conception of the data, to data acquisition and to study coordination. All authors contributed to and/or provided critical comments and suggestions on the manuscript, reviewed the final draft of the manuscript and gave final approval of the version to be published. PCD is the guarantor of this work.

Figures

Fig. 1
Fig. 1
ROC AUCs and corresponding 95% CIs of the oral DIs for: (a) discriminatory abilities for incident type 2 diabetes mellitus (T2DM) in at-baseline non-T2DM; (b) discriminatory abilities for incident T2DM in at-baseline NGM; and (c) discriminatory abilities for incident prediabetes in at-baseline NGM, CODAM study, Maastricht, the Netherlands, 1999–2009. Dashed line, ROC AUC 50%. *p < 0.05 for ROC AUC vs Matsuda index alone
See this image and copyright information in PMC

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