Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, Colorado, USA.
Pediatr Diabetes. 2020 Nov;21(7):1159-1168. doi: 10.1111/pedi.13072. Epub 2020 Jul 31.
BACKGROUND/OBJECTIVE: Rates of dysglycemia are increasing in youth, secondary to obesity and decreased insulin sensitivity (IS) in puberty. The oral minimal model (OMM) has been developed in order to measure IS using an easy oral glucose load, such as an oral glucose tolerance test (OGTT), instead of an hyperinsulinemic-euglycemic clamp (HE-clamp), a more invasive and time-consuming procedure. However, this model, following a standard 2 hour- OGTT has never been validated in youth, a population known for a different physiologic response to OGTT than adults. Thus, we compared IS measurements obtained from OMM following a 2-hour OGTT to HE-clamp and isotope tracer-assessed tissue IS in adolescents. We also compared the liver/muscle-specific IS from HE-clamp with other liver/muscle-specific IS surrogates following an OGTT previously validated in adults.
Secondary analysis of a cross-sectional study. Adolescent girls with (n = 26) and without (n = 7) polycystic ovary syndrome (PCOS) (14.6 ± 1.7 years; BMI percentile 23.3%-98.2%) underwent a 2-hour 75 g OGTT and a 4-phase HE-clamp. OMM IS (Si), dynamic Si (Si ) and other OGTT-derived muscle and liver IS indices were correlated with HE-clamp tissue-specific IS.
OMM Si and Si correlated with HE-clamp-measured peripheral IS (r = 0.64, P <.0001 and r = 0.73; P <.0001, respectively) and the correlation coefficient trended higher than the Matsuda index (r = 0.59; P =.003). The other tissue-specific indices were poorly correlated with their HE-clamp measurements.
In adolescent girls, the 2-hour OMM provided the best estimate of peripheral IS. Additional surrogates for hepatic IS are needed for youth.
背景/目的：由于肥胖和青春期胰岛素敏感性（IS）下降，年轻人的血糖异常发生率正在增加。为了使用简单的口服葡萄糖负荷（如口服葡萄糖耐量试验（OGTT））而不是更具侵入性和耗时的高胰岛素正葡萄糖钳夹（HE-钳夹）来测量 IS，开发了口服最小模型（OMM）。然而，这种模型在青少年中从未使用标准的 2 小时 OGTT 进行过验证，青少年对 OGTT 的生理反应与成年人不同。因此，我们比较了 2 小时 OGTT 后 OMM 测量的 IS 与 HE-钳夹和同位素示踪剂评估的青少年组织 IS，以及与成人之前验证过的 OGTT 相关的其他肝/肌肉特异性 IS 替代物。
这是一项横断面研究的二次分析。患有（n = 26）和不患有（n = 7）多囊卵巢综合征（PCOS）的青春期女孩（14.6 ± 1.7 岁；BMI 百分位 23.3%-98.2%）接受了 2 小时 75 g OGTT 和 4 期 HE-钳夹。将 OMM IS（Si）、动态 Si（Si ）和其他 OGTT 衍生的肌肉和肝脏 IS 指数与 HE-钳夹组织特异性 IS 相关联。
OMM Si 和 Si 与 HE-钳夹测量的外周 IS 相关（r = 0.64，P<.0001 和 r = 0.73；P<.0001，分别），且相关系数高于 Matsuda 指数（r = 0.59；P=.003）。其他组织特异性指数与 HE-钳夹测量值相关性较差。
在青春期女孩中，2 小时 OMM 提供了外周 IS 的最佳估计值。需要为年轻人寻找其他肝 IS 的替代物。
