Advertisement

Acta Diabetologica

, Volume 29, Issue 1, pp 29–33 | Cite as

Comparison of the metabolic effects of mixed meal and standard oral glucose tolerance test on glucose, insulin and C-peptide response in healthy, impaired glucose tolerance, mild and severe non-insulin-dependent diabetic subjects

  • Saverio Marena
  • Gaspare Montegrosso
  • Franco De Michieli
  • Elisabetta Pisu
  • Gianfranco Pagano
Originals

Abstract

Dietary constituents other than glucose can influence insulin secretion in non-insulin-dependent diabetes mellitus and administration of a standard mixed meal has been proposed as a more physiological test in regard to human diet for evaluating the patient both at the time of diagnosis and during follow-up. This study was carried out to compare the effects of a standard meal and the oral glucose tolerance test on glucose, insulin and C-peptide plasma levels in four groups of subjects: healthy controls, subjects with impaired glucose tolerance, patients with mild non-insulin-dependent diabetes, and non-insulin-dependent diabetic patients with secondary failure to oral agents. Plasma glucose values were significantly higher after the oral glucose tolerance test than after the mixed meal in all four groups of subjects. Plasma insulin and C-peptide values were similar during the two tests in all groups of subjects except in non-insulin-dependent diabetics with secondary failure (flattened curves). Insulin and C-peptide responses per unit rise in blood glucose were significantly higher after the oral glucose tolerance test than after the mixed meal both in mild non-insulin-dependent diabetics (P<0.05 andP<0.05) and in non-insulin-dependent diabetics in secondary failure (P<0.01 andP<0.05). There was significant correlation between oral glucose tolerance test and mixed meal glucose incremental areas (r=0.511,P<0.001). The diagnostic relevance of the test was evaluated by comparing the 120 min plasma glucose levels following mixed meal and oral glucose tolerance test: there was a significant correlation between the values in the two tests (r=0.956,P<0.001); the differences among the four groups were statistically significant and there was a partial overlap between healthy controls and impaired glucose tolerance patients: 93±3 versus 111±7 mg/dl for controls; 107±3 versus 161±5 mg/dl for impaired glucose tolerance patients; 204±11 versus 284±12 mg/dl for mild non-insulin-dependent diabetics; 309±9 versus 440±17 mg/dl for NID diabetics in secondary failure. The sensitivity of the test was 73% and specificity 100%. The mixed meal is proposed for clinical practice as a more physiological test than the standard oral glucose tolerance test for further characterization and longitudinal evaluation of patients with impaired glucose tolerance or non-insulin-dependent diabetes mellitus.

Key words

Mixed meal Oral glucose tolerance test Non-insulin-dependent diabetes mellitus 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    De Fronzo RA, The triumvirate: β-cell, muscle, liver: a collusion responsible for NIDDM. Diabetes 37: 667–687, 1988Google Scholar
  2. 2.
    Gerich JE, Role of insulin resistance in the pathogenesis of type 2 (non-insulin-dependent) diabetes mellitus. Baillière's Clin Endocrinol Metab 2: 307–326, 1988Google Scholar
  3. 3.
    Leahy J, Natural history of β-cell dysfunction in NIDDM. Diabetes Care 13: 992–1010, 1990Google Scholar
  4. 4.
    Raven GM, Role of insulin resistance in human disease. Diabetes 37: 1595–1607, 1988Google Scholar
  5. 5.
    Turner RC, Matthews DR, Clark A, O'Rahilly S, Rudenski AS, Levy J, Pathogenesis of NIDDM — a disease of deficient insulin secretion. Baillière's Clin Endocrinol Metab 2: 327–342, 1988Google Scholar
  6. 6.
    National Diabetes Data Group, Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 38: 1039–1057, 1979Google Scholar
  7. 7.
    WHO Study Group, Diabetes mellitus. World Health Organization, Geneva, 1985Google Scholar
  8. 8.
    Nuttal FQ, Gannon CM, Quantitative importance of dietary constituents other than glucose as insulin secretagogues in type II diabetes. Diabetes Care 11: 72–76, 1985Google Scholar
  9. 9.
    Turner RC, Mann II, Simpson RD, Harris E, Maxwell R, Fasting hyperglycaemia and relatively unimpaired meal responses in mild diabetes. Clin Endocrinol 6: 253–264, 1977Google Scholar
  10. 10.
    Groop L, Schalin C, Frannssila-Kallunki A, Widen E, Ekstrand A, Eriksson J, Characteristics of non-insulin-dependent diabetic patients with secondary failure to oral antidiabetic therapy. Am J Med 87: 183–190, 1989Google Scholar
  11. 11.
    Pisu E, De Benedictis D, Baggiore C, et al, Insulin supplement in type 2 diabetic patients with secondary failure to oral agents ameliorates hepatic and peripheral insulin sensitivity but not insulin secretion. Diabetic Med 7: 805–809, 1990Google Scholar
  12. 12.
    Krezowski PA, Gannon MC, Bartosh NH, Nuttal FQ, The effect of protein ingestion on the metabolic responses to oral glucose in normal individuals. Am J Clin Nutr 44: 847–856, 1986Google Scholar
  13. 13.
    Nuttal FQ, Mooradian AD, Gannon MC, Billington C, Krezowski PA, Effect of protein ingestion on the glucose and insulin response to a standardized oral glucose load. Diabetes Care 7: 463–470, 1984Google Scholar
  14. 14.
    Gannon MC, Neil BL, Wesphal SA, Nuttal FQ, The insulin and glucose responses to meals of glucose proteins in type II diabetes subjects (abstract). Diabetes 36 [Suppl 1]: 12, 1985Google Scholar
  15. 15.
    Curry DL, Curry KP, Gomez M, Fructose potentiation of insulin secretion. Endocrinology 91: 1493–1498, 1972Google Scholar
  16. 16.
    Grodsky GM, Batts AS, Bennett LL, Voella C, McWilliams NB, Smith DF, Effects of carbohydrates on secretion of insulin from isolated rat pancreas. Am J Physiol 205: 638–644, 1963Google Scholar
  17. 17.
    Collier G, O'Dea K, The effect of coingestion of fat on the glucose, insulin, and gastric inhibitory polypeptide responses to carbohydrate and protein. Am J Clin Nut 37: 941–944, 1983Google Scholar
  18. 18.
    Brown JC, Dryburgh JR, Ross SA, Dupre J, Identification and actions of gastric inhibitory polypeptide. Recent Prog Horm Res 31: 487–532, 1975Google Scholar
  19. 19.
    Collier G, McLean A, O'Dea K, Effect of coingestion of fat on the metabolic responses to slowly and rapidly absorbed carbohydrates. Diabetologia 26: 50–54, 1984Google Scholar
  20. 20.
    Simpson RW, McDonald J, Wahlqvist ML Atley L, Outch K, Macronutrients have different metabolic effect in nondiabetics and diabetics. Am J Clin Nutr 37: 941–944, 1983Google Scholar
  21. 21.
    Estrich D, Ravnick A, Schliert G, Fukayama G, Kinsell L, Effect of co-ingestion of fat and protein upon carbohydrate-induced hyperglycemia. Diabetes 16: 232–237, 1967Google Scholar
  22. 22.
    Lillioja S, Mott DM, Howard BV, et al, Impaired glucose tolerance as a disorder of insulin action. N Engl J Med 318: 1217–1224, 1988Google Scholar
  23. 23.
    Saad MF, Knowler WC, Pettitt DJ, Nelson RG, Charles MA, Bennet PH, A two-step model for development of non-insulin-dependent diabetes. Am J Med 90: 229–235, 1991Google Scholar
  24. 24.
    Nuttal FQ, Mooradian AD, De Marais R, Parker S, The glycemic effect of different meals approximately isocaloric and similar in protein, carbohydrate and fat content as calculated using the ADA exchange lists. Diabetes Care 6: 432–435, 1983Google Scholar

Copyright information

© Springer-Verlag 1992

Authors and Affiliations

  • Saverio Marena
    • 1
  • Gaspare Montegrosso
    • 1
  • Franco De Michieli
    • 1
  • Elisabetta Pisu
    • 1
  • Gianfranco Pagano
    • 1
  1. 1.Istituto di Medicina Interna dell'Università di TorinoTorinoItaly

Personalised recommendations