Accuracy of the 13C-glucose breath test to identify insulin resistance in non-diabetic adults
- 28 Downloads
To assess the validity of the 13C-glucose breath test (13C-GBT) to identify insulin resistance (IR) in non-diabetic individuals, using hyperinsulinemic–euglycemic clamps as gold standard. This validity was compared with that of other IR surrogates.
Non-diabetic adults were studied in a cross-sectional design. In a first appointment, oral glucose tolerance tests were conducted simultaneously with 13C-GBTs. Oral 75 g glucose dissolved in 150 ml water, followed by 1.5 mg/Kg body weight U-13C-glucose dissolved in 50 ml water, was administered. Breath and blood samples were collected at baseline and at 30-min intervals. The percentages of glucose-oxidized dose at given periods were calculated. Clamps were conducted a week later. A clamp-derived M value ≤ 6.0 mg/kg*min was used as cut-off. ROC curves were constructed for 13C-GBT, fasting insulin, HOMA, and ISI-composite.
Thirty-eight subjects completed the study protocol. The correlation coefficient between the 13C-GBT derived glucose-oxidized dose at 180 min and M values was 0.524 (p = 0.001). The optimal value to identify IR with the 13C-GBT was 4.23% (AUC 0.81; 95CI 0.66, 0.96; accuracy 0.82, 95CI 0.66, 0.92). The 13C-GBT sensitivity (0.88) was higher than HOMA and fasting insulin sensitivities (0.83 and 0.75 respectively), while their specificities were comparable (0.71, 0.71, and 0.79, respectively). The sensitivity of ISI-C was higher (0.92) than that of the 13C-GBT, but its specificity was poor (0.36). The accuracy of the 13C-GBT was superior to that of the other studied surrogates.
The 13C-GBT is a valid and accurate method to detect IR in non-diabetic adults. Therefore, it is potentially useful in clinical and community settings.
KeywordsInsulin resistance 13C-glucose breath test Hyperinsulinemic–euglycemic clamp ISI-composite Accuracy ROC curve
This study was supported with grants from: Consejo Nacional de Ciencia y Tecnología (CONACYT): 068915, and from the Instituto Mexicano del Seguro Social: FIS/IMSS/PROT 2007-3603-18.
Compliance with ethical standards
Conflict of interest
Authors declare that no competing financial interests exist.
The protocol was approved by the Ethics Committee of the Instituto Mexicano del Seguro Social and with the 1964 Helsinki declaration (Approval Number: R-2007-3603-18).
Informed consent was obtained from all individual participants included in the study before the study protocol initiated.
- 2.Wilcox G (2005) Insulin and insulin resistance. Clin Biochem Rev 26:19–39Google Scholar
- 6.DeFronzo RA, Tobin JD, Andrews R (1979) Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol 237:E214–E223Google Scholar
- 10.Mooy JM, Grootenhuis PA, de Vries H, Kostense PJ, Popp-Snidders C, Bouter LM, Heine RJ (1996) Intra-individual variation of glucose, specific insulin and proinsulin concentrations measured by two oral glucose tolerance tests in a general caucasian population: the hoorn study. Diabetologia 39:298–305CrossRefGoogle Scholar
- 17.Ziakun AM, Maevskiĭ EI, Sokolov EI, Starkova NT, Davydov AL, Grishina EV, Kudriavtseva AI, Zakharchenko VN, Peshenko VP, Shidlovskiĭ M (2004) Evaluation of glucose utilization in patients with insulin-independent diabetes mellitus by using breathing test. Biofizika 49:948–957Google Scholar
- 20.Maldonado-Hernández J, Martínez-Basila A, Matute González MG, López-Alarcón MG (2014) The [13C] glucose breath rest is a reliable method to identify insulin resistance in Mexican adults without diabetes: comparison with other insulin resistance surrogates. Diabetes Technol Ther 16:1–7CrossRefGoogle Scholar