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Pediatr Diabetes. 2019 May;20(3):282-285. doi: 10.1111/pedi.12816. Epub 2019 Feb 19.

Mixed-meal tolerance test to assess residual beta-cell secretion: Beyond the area-under-curve of plasma C-peptide concentration.

Author information

1
Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
2
Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
3
Department of Paediatrics, University of Cambridge, Cambridge, UK.

Abstract

AIMS:

Residual beta-cell secretion in type 1 diabetes is commonly assessed by area-under-curve of plasma C-peptide concentration (AUCCpep ) following mixed-meal tolerance test (MMTT). We aimed to investigate alternative measures of beta-cell responsiveness.

METHODS:

We analyzed data from 32 youth (age 7 to 17 years) undergoing MMTT within 6 months of type 1 diabetes diagnosis. We related AUCCpep with (a) validated mechanistic index of postprandial beta-cell responsiveness MI accounting for glucose level during MMTT, and (b) pragmatic marker calculated as baseline plasma C-peptide concentration corrected for baseline plasma glucose concentration.

RESULTS:

Postprandial responsiveness MI was correlated with age and BMI SDS (Rs = 0.66 and 0.44, P < 0.01 and P < 0.05) and was more correlated with glycated hemoglobin than AUCCpep (Rs = 0.79, P = 0.04). The pragmatic marker was highly correlated with AUCCpep (Rs = 0.94, P < 0.01).

CONCLUSIONS:

Postprandial responsiveness MI may be more relevant to glucose control than AUCCpep . Baseline C-peptide corrected for baseline glucose appears to be a suitable surrogate of AUCCpep if MMTT is not performed.

KEYWORDS:

C-peptide; beta-cell secretion; mixed-meal tolerance test; type 1 diabetes

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