The 13C-Glucose Breath Test for Insulin Resistance Assessment in Adolescents: Comparison with Fasting and Post-Glucose Stimulus Surrogate Markers of Insulin Resistance

Abstract

Objective:To evaluate the use of the 13C-glucose breath test (13C-GBT) for insulin resistance (IR) detection in adolescents through comparison with fasting and post-glucose stimulus surrogates.Methods:One hundred thirty-three adolescents aged between 10 and 16 years received an oral glucose load of 1.75 g per kg of body weight dissolved in 150 mL of water followed by an oral dose of 1.5 mg/kg of U-13C-Glucose, without a specific maximum dose. Blood samples were drawn at baseline and 120 minutes, while breath samples were obtained at baseline and at 30, 60, 90, 120, 150, and 180 minutes. The 13C-GBT was compared to homeostasis model assessment (HOMA) IR (≥p95 adjusted by gender and age), fasting plasma insulin (≥p90 adjusted by gender and Tanner stage), results of 2-h oral glucose tolerance test (OGTT), insulin levels (≥65 μU/mL) in order to determine the optimal cut-off point for IR diagnosis.Results:13C-GBT data, expressed as adjusted cumulative percentage of oxidized dose (A% OD), correlated inversely with fasting and post-load IR surrogates. Sexual development alters A% OD results, therefore individuals were stratified into pubescent and post-pubescent. The optimal cut-off point for the 13C-GBT in pubescent individuals was 16.3% (sensitivity=82.8% & specificity=60.6%) and 13.0% in post-pubescents (sensitivity=87.5% & specificity=63.6%), when compared to fasting plasma insulin. Similar results were observed against HOMA and 2-h OGTT insulin.Conclusion:The 13C-GBT is a practical and non-invasive method to screen for IR in adolescents with reasonable sensitivity and specificity.

Optimal Cut-off Points of Fasting and Post-Glucose Stimulus Surrogates of Insulin Resistance as Predictors of Metabolic Syndrome in Adolescents According to Several Definitions

“…The data from this cross-sectional study correspond to two previous studies published by our group ( 11 , 12 ). One hundred fifty-five apparently healthy adolescents aged between 10 and 18 years from an open population living in Mexico City were enrolled during 2011 and 2012.…”

Oxygen-18 and carbon-13 isotopes in eCO2 and erythrocytes carbonic anhydrase activity of Finnish prediabetic population

“…The latest research lines in the field of isotopeselective breath testing include early sepsis and infection detection [7,[10][11][12] and prediabetes (PD) and type 2 diabetes (T2D) screening [8]. These applications are based on monitoring the breath delta values (BDVs, ‰) of 18 O/ 16 O and/or 13 C/ 12 C in eCO 2 (i.e. δ 18 O and δ 13 C) and rely on the natural fluctuation in the isotope ratios during innate or induced metabolic events [2,9,11]; thus, no labeling is used.…”

“…These applications are based on monitoring the breath delta values (BDVs, ‰) of 18 O/ 16 O and/or 13 C/ 12 C in eCO 2 (i.e. δ 18 O and δ 13 C) and rely on the natural fluctuation in the isotope ratios during innate or induced metabolic events [2,9,11]; thus, no labeling is used. Typically, delta-over-baseline (DOB, ‰) values, i.e.…”

“…shift in BDV in relation to the baseline, are utilized in diagnostic purposes. BDVs of 18 O/ 16 O and 13 C/ 12 C are often calculated in relation to an international Vienna Pee Dee Belminite (VPDB) standard. DOB values (i.e.…”

13 C isotopic abundances in natural nutrients: a newly formulated test meal for non-invasive diagnosis of type 2 diabetes

“…Recently, a 13 C-glucose breath test has been proposed as an alternative non-invasive method to monitor insulin resistance in T2D [4][5][6][7][8][9][10]. The subject under investigation is allowed to take an oral dose of carbon-13 ( 13 C)-labelled glucose, which is metabolized in the body to produce isotope-enriched carbon dioxide ( 13 CO 2 ) which is subsequently detected in exhaled breath.…”