Stinson E J, Mitchell C M, Looker H C, Krakoff J, Chang D C
Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 4212 N. 16th Street, Phoenix, AZ, 85016, USA.
J Endocrinol Invest. 2024 Mar;47(3):699-707. doi: 10.1007/s40618-023-02187-0. Epub 2023 Sep 9.
Prior research has focused on glucose/insulin responses to meal challenges to create personalized diets to improve health, though it is unclear if these responses predict chronic diseases. We aimed to identify glucose and insulin responses to a mixed meal tolerance test (MMTT) that predict the development of diabetic retinopathy (DR) and compare the predictive abilities with the oral glucose tolerance test (OGTT).
Indigenous American adults without diabetes (n = 168) underwent a 4-h MMTT, body composition assessment, and a 3-h OGTT at baseline. During follow-up (median 13.4 years), DR was diagnosed by direct ophthalmoscopy (n = 28) after onset of type 2 diabetes. Total and incremental area under the curve (AUC and iAUC) were calculated from glucose/insulin responses after the MMTT and OGTT.
In separate Cox proportional hazards models adjusted for age, sex, and body fat (%), MMTT glucose AUCs (180-min and 240-min) and iAUC (180-min) predicted DR (HR 1.50, 95% CI 1.06, 2.12; HR 1.50, 95% CI 1.05, 2.14; HR 1.58, 95% CI 1.01, 2.46). The predictive abilities were better than the fasting OGTT glucose (p < 0.01) but similar to the 120-min OGTT glucose (p = 0.53). MMTT insulin AUCs (180-min and 240-min) and iAUC (180-min) also predicted DR (HR 1.65, 95% CI 1.09, 2.51; HR 1.58, 95% CI 1.00, 2.35; HR 1.53 95% CI 1.06, 2.22) while insulin AUC and iAUC from the OGTT did not (p > 0.05).
Higher MMTT glucose and insulin responses predicted DR and were comparable to the OGTT, supporting the use of a meal challenge for precision nutrition.
Clinical Trial Registry: ClinicalTrials.gov identifier: NCT00340132, NCT00339482.
先前的研究聚焦于葡萄糖/胰岛素对进餐挑战的反应，以制定个性化饮食来改善健康，尽管尚不清楚这些反应是否能预测慢性疾病。我们旨在确定混合餐耐量试验（MMTT）中预测糖尿病视网膜病变（DR）发展的葡萄糖和胰岛素反应，并将其预测能力与口服葡萄糖耐量试验（OGTT）进行比较。
无糖尿病的美国原住民成年人（n = 168）在基线时接受了4小时的MMTT、身体成分评估和3小时的OGTT。在随访期间（中位时间13.4年），2型糖尿病发病后通过直接检眼镜检查诊断出DR（n = 28）。根据MMTT和OGTT后的葡萄糖/胰岛素反应计算曲线下总面积（AUC）和增量面积（iAUC）。
在根据年龄、性别和体脂（%）调整的Cox比例风险模型中，MMTT葡萄糖AUC（180分钟和240分钟）和iAUC（180分钟）可预测DR（风险比1.50，95%置信区间1.06，2.12；风险比1.50，95%置信区间1.05，2.14；风险比1.58，95%置信区间1.01，2.46）。其预测能力优于空腹OGTT葡萄糖（p < 0.01），但与120分钟OGTT葡萄糖相似（p = 0.53）。MMTT胰岛素AUC（180分钟和240分钟）和iAUC（180分钟）也可预测DR（风险比1.65，95%置信区间1.09，2.51；风险比1.58，95%置信区间1.00，2.35；风险比1.53，95%置信区间1.06，2.22），而OGTT的胰岛素AUC和iAUC则不能（p > 0.05）。
较高的MMTT葡萄糖和胰岛素反应可预测DR，且与OGTT相当，支持将进餐挑战用于精准营养。
临床试验注册：ClinicalTrials.gov标识符：NCT00340132，NCT00339482。
