Takakado Misaki, Takata Yasunori, Yamagata Fumio, Yaguchi Michiko, Hiasa Go, Sato Sumiko, Funada Jun-Ichi, Kawazu Shoji, Osawa Haruhiko
Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
BMJ Open Diabetes Res Care. 2020 Feb;8(1). doi: 10.1136/bmjdrc-2019-000984.
To establish a simple screening method for diabetes based on myoinositol (MI) in urine samples collected at home.
Initially, we evaluated the stability of urinary MI (UMI) at room temperature (RT; 25°C) and 37°C in 10 outpatients with type 2 diabetes. We then enrolled 115 volunteers without a current or history of diabetes. In all subjects, glucose intolerance was diagnosed by 75 g oral glucose tolerance test (75gOGTT). To assess the association between UMI or urine glucose (UG) and plasma glucose (PG), urine samples were also collected at 0 and 2 hours during 75gOGTT. All the subjects collected urine samples at home before and 2 hours after consuming the commercially available test meal. UMI levels at wake-up time (UMI), before (UMI) and 2 hours after the test meal (UMI) were measured using an enzymatic method. ΔUMI was defined as UMI minus UMI.
Differing from UG, UMI was stable at RT and 37°C. UMI was increased linearly along with an increase in PG, and no threshold for UMI was observed. UMI was closely associated with blood glucose parameters obtained from a 75gOGTT and hemoglobin A1c (HbA1c) at hospital after adjustment for age, sex, body mass index and serum creatinine. UMI, UMI, UMI and ΔUMI at home were higher in diabetic subjects than non-diabetic subjects even after the above adjustment. Receiver operating characteristics curve (ROC) analyses revealed that for the screening of diabetes, the area under the curve for ROC for UMI and ΔUMI (0.83 and 0.82, respectively) were not inferior to that for HbA1c ≥48 mmol/mol, which is the American Diabetes Association (ADA) criteria for diabetes.
MI measurement in urine samples collected at home before and after the meal would be a simple, non-invasive and valuable screening method for diabetes.
建立一种基于在家收集的尿液样本中肌醇（MI）的糖尿病简易筛查方法。
首先，我们评估了10名2型糖尿病门诊患者尿液MI（UMI）在室温（RT；25°C）和37°C下的稳定性。然后，我们招募了115名无糖尿病现患或病史的志愿者。所有受试者均通过75克口服葡萄糖耐量试验（75gOGTT）诊断葡萄糖耐量异常。为评估UMI或尿糖（UG）与血糖（PG）之间的关联，在75gOGTT期间的0小时和2小时也采集了尿液样本。所有受试者在食用市售测试餐之前和之后2小时在家中采集尿液样本。使用酶法测量起床时的UMI水平（UMI）、测试餐前（UMI）和测试餐后2小时（UMI）的UMI水平。ΔUMI定义为UMI减去UMI。
与UG不同，UMI在室温及37°C下稳定。UMI随PG升高呈线性增加，未观察到UMI阈值。在校正年龄、性别、体重指数和血清肌酐后，UMI与在医院通过75gOGTT获得的血糖参数及糖化血红蛋白（HbA1c）密切相关。即使经过上述校正，糖尿病患者在家中的UMI、UMI、UMI和ΔUMI仍高于非糖尿病患者。受试者工作特征曲线（ROC）分析显示，对于糖尿病筛查，UMI和ΔUMI的ROC曲线下面积（分别为0.83和0.82）不低于美国糖尿病协会（ADA）糖尿病标准中HbA1c≥48 mmol/mol的曲线下面积。
在家中采集的餐前和餐后尿液样本中测量MI将是一种简单、无创且有价值的糖尿病筛查方法。
