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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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    Figure 1—

    The computed slopes (——) and 95% CIs for the slopes (– – –) for ln(ΔI0–30/ΔG0–30) versus ln(1/fasting insulin) are plotted for subjects with NGT (slope −0.87 [95% CI −1.13 to −0.61]) (A), IGM (−0.84 [−1.05 to −0.63]) (B), and diabetes (DM) (−0.76 [−1.16 to −0.35]) (C). D: The hyperbolic curves for NGT, IGM, and diabetes, assuming a slope of −1, are plotted for ΔI0–30/ΔG0–30 versus 1/fasting insulin.

  • Figure 2—
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    Figure 2—

    A: The DIO (ΔI0–30/ΔG0–30 × 1/fasting insulin) decreases from NGT to IGM to diabetes (DM) (median [interquartile range]). B: The logarithmic means for baseline ΔI0–30/ΔG0–30 and 1/fasting insulin values are plotted for subjects with NGT (▪ and □) and IGM (• and ○) as nonprogressors (▪ and •) and progressors (□ and ○) relative to the hyperbolic curves. Progressors had lower β-cell function at baseline. C: The number of subjects who developed diabetes over the 10-year follow-up period by quintiles of baseline DIO. D: ROC curves comparing ability of baseline ΔI0–30/ΔG0–30 (dotted line), 1/fasting insulin (dashed line), and DIO (solid line) to predict cumulative diabetes at 10 years.

Tables

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  • Table 1—

    Subject characteristics by glucose tolerance category

    NGTiIFGiIGTIFG + IGTIGMDiabetes
    n2446011876254115
    Age (years) (mean ± SD)48.6 ± 11.956.4 ± 10.754.0 ± 11.559.1 ± 9.5§56.1 ± 10.9*61.1 ± 7.4*
    Sex (female/male)120/12420/4079/39†23/53§122/13249/66
    BMI (kg/m2)23.5 ± 0.224.7 ± 0.323.7 ± 0.325.8 ± 0.4§24.6 ± 0.2*25.7 ± 0.3*
    Abdominal circumference (cm)84.0 ± 0.5187.7 ± 0.885.5 ± 0.990.0 ± 0.9§87.6 ± 0.5*91.0 ± 0.8*
    FPG (mmol/l)4.89 (0.58)5.72 (0.39)5.06 (0.50)†5.89 (0.39)§5.56 (0.72)*7.56 (3.33)*
    2-h plasma glucose (mmol/l)6.22 (1.44)6.94 (1.08)8.69 (1.11)†9.19 (1.78)‡§8.47 (1.56)*15.17 (8.56)*
    Fasting insulin (pmol/l)66 (36)81 (48)69 (48)78 (51)78 (54)*102 (96)*
    HOMA-S81.9 (45.2)63.9 (36.4)79.2 (50.2)65.8 (38.8)70.7 (46.9)*47.0 (44.7)*
    ΔI0–30/ΔG0–30 (pmol/mmol)105.7 (102.5)100.2 (101.9)81.7 (92.6)77.9 (65.0)80.9 (86.5)*29.9 (41.4)*
    incAUCins/glu (pmol/mmol)148.6 (138.6)138.5 (146.5)104.3 (83.8)†105.6 (77.8)‡113.3 (90.8)*33.8 (49.0)*
    • Data are reported as mean ± SEM or median (interquartile range) unless otherwise specified.

    • *

      ↵* P < 0.001 NGT versus IGM versus diabetes;

    • †

      ↵† iIFG versus iIGT,

    • ‡

      ↵‡ iIFG versus IFG + IGT,

    • §

      ↵§ iIGT versus IFG + IGT, P < 0.05.

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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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