Pathophysiological Characteristics Underlying Different Glucose Response Curves: A Latent Class Trajectory Analysis From the Prospective EGIR-RISC Study

Abstract

The latent class analysis approach is a pathophysiologically insightful way to classify individuals without diabetes based on their response to glucose during an OGTT.

The Shape of the Glucose Response Curve During an Oral Glucose Tolerance Test: Forerunner of Heightened Glycemic Failure Rates and Accelerated Decline in β-Cell Function in TODAY

“…In summary, the current study is the first to demonstrate that in youths with established type 2 diabetes, the incessant increase OGTT glucose response curve reflects reduced b-cell function at randomization and foretells increased glycemic failure rates with accelerated deterioration in b-cell function independent of diabetes duration and treatment assignment compared with monophasic and biphasic curves. It remains to be determined 1) whether in youths with type 2 diabetes, the OGTT glucose response curve could serve as a metabolic biomarker prognosticating response to therapy and 2) which of the different metabolic biomarkers, OGTT glucose response patterns or time to glucose peak, elegantly described very recently in adults without diabetes in the EGIR-RISC (the European Group for the Study of Insulin Resistance: Relationship between Insulin Sensitivity and Cardiovascular Disease Risk) study (24), could serve as a metabolic biomarker prognosticating response to therapy.…”

Glucose Measurements at Various Time Points During the OGTT and Their Role in Capturing Glucose Response Patterns

“…Intermediate time points during the oral glucose tolerance test (OGTT) have received more attention recently (1), with some researchers even suggesting to use 1-h glucose when screening for prediabetes (2). We demonstrated that characterization of glucose response patterns from OGTTs with five time points provides useful insights into the heterogeneity of type 2 diabetes development (3). Although such analyses are feasible in small pathophysiological investigations, they are not common in large epidemiological studies where the number of glucose measurements during an OGTT is often limited.…”

Comment on Scholtens et al. Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (HAPO FUS): Maternal Glycemia and Childhood Glucose Metabolism. Diabetes Care 2019;42:381–392

“…The authors also tested a quadratic model (and found it to be the best), which is also problematic but for a different reason. During the 2-h OGTT, most individuals have an initial rise in their glucose level followed by a decline (2). However, the rate of decline has to slow down at some point to reach a rather constant level again (which usually happens within 2 h in the general population).…”