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Cardiovascular and Metabolic Risk

Oral Disposition Index Predicts the Development of Future Diabetes Above and Beyond Fasting and 2-h Glucose Levels

  1. Kristina M. Utzschneider, MD12,
  2. Ronald L. Prigeon, MD34,
  3. Mirjam V. Faulenbach, MD12,
  4. Jenny Tong, MD, MPH12,
  5. Darcy B. Carr, MD, MS5,
  6. Edward J. Boyko, MD, MPH6,
  7. Donna L. Leonetti, PHD7,
  8. Marguerite J. McNeely, MD2,
  9. Wilfred Y. Fujimoto, MD2 and
  10. Steven E. Kahn, MB, CHB12
  1. 1Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
  2. 2Department of Medicine, University of Washington, Seattle, Washington
  3. 3Geriatric Research Education and Clinical Center, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland
  4. 4Division of Gerontology, University of Maryland School of Medicine, Baltimore, Maryland
  5. 5Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
  6. 6Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
  7. 7Department of Anthropology, University of Washington, Seattle, Washington
  1. Corresponding author: Kristina M. Utzschneider, kutzschn{at}u.washington.edu
Diabetes Care 2009 Feb; 32(2): 335-341. https://doi.org/10.2337/dc08-1478
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Abstract

OBJECTIVE—We sought to determine whether an oral disposition index (DIO) predicts the development of diabetes over a 10-year period. First, we assessed the validity of the DIO by demonstrating that a hyperbolic relationship exists between oral indexes of insulin sensitivity and β-cell function.

RESEARCH DESIGN AND METHODS—A total of 613 Japanese-American subjects (322 men and 291 women) underwent a 75-g oral glucose tolerance test (OGTT) at baseline, 5 years, and 10 years. Insulin sensitivity was estimated as 1/fasting insulin or homeostasis model assessment of insulin sensitivity (HOMA-S). Insulin response was estimated as the change in insulin divided by change in glucose from 0 to 30 min (ΔI0–30/ΔG0–30).

RESULTS—ΔI0–30/ΔG0–30 demonstrated a curvilinear relationship with 1/fasting insulin and HOMA-S with a left and downward shift as glucose tolerance deteriorated. The confidence limits for the slope of the loge-transformed estimates included −1 for ΔI0–30/ΔG0–30 versus 1/fasting insulin for all glucose tolerance groups, consistent with a hyperbolic relationship. When HOMA-S was used as the insulin sensitivity measure, the confidence limits for the slope included −1 only for subjects with normal glucose tolerance (NGT) or impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) but not diabetes. On the basis of this hyperbolic relationship, the product of ΔI0–30/ΔG0–30 and 1/fasting insulin was calculated (DIO) and decreased from NGT to IFG/IGT to diabetes (P < 0.001). Among nondiabetic subjects at baseline, baseline DIO predicted cumulative diabetes at 10 years (P < 0.001) independent of age, sex, BMI, family history of diabetes, and baseline fasting and 2-h glucose concentrations.

CONCLUSIONS—The DIO provides a measure of β-cell function adjusted for insulin sensitivity and is predictive of development of diabetes over 10 years.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 28 October 2008.

    Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted October 16, 2008.
    • Received August 11, 2008.
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Oral Disposition Index Predicts the Development of Future Diabetes Above and Beyond Fasting and 2-h Glucose Levels
Kristina M. Utzschneider, Ronald L. Prigeon, Mirjam V. Faulenbach, Jenny Tong, Darcy B. Carr, Edward J. Boyko, Donna L. Leonetti, Marguerite J. McNeely, Wilfred Y. Fujimoto, Steven E. Kahn
Diabetes Care Feb 2009, 32 (2) 335-341; DOI: 10.2337/dc08-1478

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Oral Disposition Index Predicts the Development of Future Diabetes Above and Beyond Fasting and 2-h Glucose Levels
Kristina M. Utzschneider, Ronald L. Prigeon, Mirjam V. Faulenbach, Jenny Tong, Darcy B. Carr, Edward J. Boyko, Donna L. Leonetti, Marguerite J. McNeely, Wilfred Y. Fujimoto, Steven E. Kahn
Diabetes Care Feb 2009, 32 (2) 335-341; DOI: 10.2337/dc08-1478
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