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Accuracy of the 13C-glucose breath test to identify insulin resistance in non-diabetic adults

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Abstract

Aims

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.

Methodology

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.

Results

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.

Conclusions

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.

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Acknowledgements

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.

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Authors and Affiliations

  1. Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, 06720, México City, Mexico

    Jorge Maldonado-Hernández, Azucena Martínez-Basila & Mardia López-Alarcón

  2. Unit of Research in Clinical Epidemiology, Centro Médico Nacional “Siglo XXI”, Instituto Mexicano del Seguro Social, Mexico City, Mexico

    Mario Enrique Rendón-Macías

Authors
  1. Jorge Maldonado-Hernández
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  2. Azucena Martínez-Basila
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  3. Mario Enrique Rendón-Macías
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  4. Mardia López-Alarcón
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Corresponding author

Correspondence to Mardia López-Alarcón.

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Authors declare that no competing financial interests exist.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study before the study protocol initiated.

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Maldonado-Hernández, J., Martínez-Basila, A., Rendón-Macías, M.E. et al. Accuracy of the 13C-glucose breath test to identify insulin resistance in non-diabetic adults. Acta Diabetol 56, 923–929 (2019). https://doi.org/10.1007/s00592-019-01318-5

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  • DOI: https://doi.org/10.1007/s00592-019-01318-5

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