Lessons From the Mixed-Meal Tolerance Test

• DOI: 10.2337/dc12-0836
• Publication Date: 2012-10-31T05:11:34Z
• Authors: Rachel E.J. Besser; Beverley M. Shields; Rosaura Casas; Andrew T. Hattersley; Johnny Ludvigsson
• Keywords: Male; Medicin och hälsovetenskap; Adolescent; C-Peptide; Fasting; Postprandial Period; Medical and Health Sciences; 3. Good health; 03 medical and health sciences; Diabetes Mellitus, Type 1; 0302 clinical medicine; Humans; Female; Child; Original Research

OBJECTIVE Mixed-meal tolerance test (MMTT) area under the curve C-peptide (AUC CP) is gold-standard measure of endogenous insulin secretion in type 1 diabetes but intensive and invasive to perform. The 90-min MMTT-stimulated CP ≥0.2 nmol/L (90CP) related improved clinical outcomes, ≥0.1 equivalent fasting (FCP). We assessed whether 90CP or FCP are alternatives a full MMTT. RESEARCH DESIGN AND METHODS was measured during 1,334 MMTTs 421 patients aged <18 years at 3, 9, 18, 48, 72 months duration. assessed: 1) correlation between mean AUC FCP; 2) sensitivity specificity ≥ 0.1 detect peak CP; 3) how time taken reach varied with age diagnosis RESULTS highly correlated (rs = 0.96; P < 0.0001) strongly 0.84; 0.0001). ≥23 nmol/L/150 min cutoff for (98% sensitivity/97% specificity). A correctly classified 96% using CP, whereas 83 85% patients, respectively. There only small difference seen (median 0.02 nmol/L). occurred earlier longer duration (6.1 each 1-year increase duration) younger (2.5 increase). CONCLUSIONS sensitive specific children adolescents offers practical alternative