Assessment of insulin resistance by a 13C glucose breath test: a new tool for early diagnosis and follow-up of high-risk patients

Meir Mizrahi, Gadi Lalazar, Tomer Adar, Itamar Raz, Yaron Ilan, Meir Mizrahi, Gadi Lalazar, Tomer Adar, Itamar Raz, Yaron Ilan

Abstract

Background/aims: Insulin resistance (IR) plays an important role in the pathogenesis of diabetes and non-alcoholic fatty liver disease (NAFLD). Current methods for insulin resistance detection are cumbersome, or not sensitive enough for early detection and follow-up. The BreathID system can continuously analyse breath samples in real-time at the point-of-care. Here we determined the efficacy of the BreathID using the 13C-Glucose breath test (GBT) for evaluation of insulin resistance.

Methods: Twenty healthy volunteers were orally administered 75 mg of 13C-glucose 1-13C. An oral glucose tolerance test (OGTT) was performed immediately; followed by serum glucose and insulin level determinations using GBT. GBT and OGTT were repeated following exercise, which alters insulin resistance levels.

Results: Within-subject correlations of GBT parameters with serum glucose and serum insulin levels were high. Before and after exercise, between-subjects correlations were high between the relative insulin levels and the % dose recoveries at 90 min (PDR 90), and the cumulative PDRs at 60 min (CPDR 60). Pairwise correlations were identified between pre-exercise Homeostasis Model Assessment (HOMA) IR at 90 min and PDR 90; HOMA B (for beta cell function) 120 and CPDR 30; HOMA IR 60 and peak time post-exercise; and HOMA B 150 with PDR 150.

Conclusions: The non-invasive real-time BreathID GBT reliably assesses changes in liver glucose metabolism, and the degree of insulin resistance. It may serve as a non-invasive tool for early diagnosis and follow up of patients in high-risk groups.

Figures

Figure 1
Figure 1
Patients underwent oral glucose tolerance test and glucose breath test. Correlation between serum glucose levels in the oral glucose tolerance test and PDR in a patient with BMI > 30 (A) before exercise; (B) after exercise; and for a patient with BMI < 30 (C) before exercise; and (D) after exercise.
Figure 2
Figure 2
Correlations were calculated between glucose levels and CPDR in (A) a patient with BMI > 30; and (B) in a patient with BMI < 30. Each dot represents a point of time following oral administration of glucose.
Figure 3
Figure 3
Correlations between serum insulin levels and PDR in (A) a patient with BMI > 30 before exercise; and (B) after exercise; and (C) in a patient with BMI < 30 before exercise; and (D) after exercise.
Figure 4
Figure 4
Correlations between insulin levels and CPDR in (A) a patient with BMI > 30; and in (B) a patient with BMI < 30. Each dot represents a point of time following oral administration of glucose.
Figure 5
Figure 5
Correlations between the median value of glucose levels for all patients together every 30 minutes during OGTT and PDR every 30 min. in (A) and (B) for CPDR every 30 min; and correlations between the median value of insulin levels for all patients together every 30 minutes during OGTT and PDR every 30 min. (C); and (D) for CPDR every 30 min.
Figure 6
Figure 6
Correlations between the median value of HOMA IR for all patients together every 30 minutes during OGTT and PDR every 30 min. in (A) and (B) for CPDR and HOMA B every 30 min.

References

    1. Fernandez-Real JM, Pickup JC. Innate immunity, insulin resistance and type 2 diabetes. Trends Endocrinol Metab. 2008;19:10–6. doi: 10.1016/j.tem.2007.10.004.
    1. Fonseca VA. Early identification and treatment of insulin resistance: impact on subsequent prediabetes and type 2 diabetes. Clin Cornerstone. 2007;8(Suppl 7):S7–18. doi: 10.1016/S1098-3597(07)80017-2.
    1. Kashyap SR, Defronzo RA. The insulin resistance syndrome: physiological considerations. Diab Vasc Dis Res. 2007;4:13–9. doi: 10.3132/dvdr.2007.001.
    1. Iqbal N. The burden of type 2 diabetes: strategies to prevent or delay onset. Vasc Health Risk Manag. 2007;3:511–20.
    1. Rose DP, Haffner SM, Baillargeon J. Adiposity, the metabolic syndrome, and breast cancer in African-American and white American women. Endocr Rev. 2007;28:763–77. doi: 10.1210/er.2006-0019.
    1. Muniyappa R, Lee S, Chen H, Quon MJ. Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage. Am J Physiol Endocrinol Metab. 2008;294:E15–26. doi: 10.1152/ajpendo.00645.2007.
    1. Di Filippo C, Verza M, Coppola L, Rossi F, D'Amico M, Marfella R. Insulin resistance and postprandial hyperglycemia the bad companions in natural history of diabetes: effects on health of vascular tree. Curr Diabetes Rev. 2007;3:268–73. doi: 10.2174/157339907782330012.
    1. Elghblawl E. Polycystic ovary syndrome and female reproduction. Br J Nurs. 2007;16:1118–21.
    1. Erhardt LR. Rationale for multiple risk intervention: the need to move from theory to practice. Vasc Health Risk Manag. 2007;3:985–97.
    1. George J, Liddle C. Nonalcoholic fatty liver disease: pathogenesis and potential for nuclear receptors as therapeutic targets. Mol Pharm. 2008;5:49–59. doi: 10.1021/mp700110z.
    1. Giovannucci E. Metabolic syndrome, hyperinsulinemia, and colon cancer: a review. Am J Clin Nutr. 2007;86:s836–42.
    1. Hsing AW, Sakoda LC, Chua S Jr. Obesity, metabolic syndrome, and prostate cancer. Am J Clin Nutr. 2007;86:s843–57.
    1. Hsu IR, Kim SP, Kabir M, Bergman RN. Metabolic syndrome, hyperinsulinemia, and cancer. Am J Clin Nutr. 2007;86:s867–71.
    1. Pollack MN. Insulin, insulin-like growth factors, insulin resistance, and neoplasia. Am J Clin Nutr. 2007;86:s820–2.
    1. Bloomgarden ZT. Insulin resistance concepts. Diabetes Care. 2007;30:1320–6. doi: 10.2337/dc07-zb05.
    1. Shoelson SE, Herrero L, Naaz A. Obesity, inflammation, and insulin resistance. Gastroenterology. 2007;132:2169–80. doi: 10.1053/j.gastro.2007.03.059.
    1. Steinberg GR. Inflammation in obesity is the common link between defects in fatty acid metabolism and insulin resistance. Cell Cycle. 2007;6:888–94.
    1. Ilan Y. Review article: the assessment of liver function using breath tests. Aliment Pharmacol Ther. 2007;26:1293–302. doi: 10.1111/j.1365-2036.2007.03519.x.
    1. Horowitz JF. Exercise-induced alterations in muscle lipid metabolism improve insulin sensitivity. Exerc Sport Sci Rev. 2007;35:192–6. doi: 10.1097/jes.0b013e318156e084.
    1. Bloomgarden ZT. Measures of insulin sensitivity. Clin Lab Med. 2006;26:611–33. doi: 10.1016/j.cll.2006.06.007. vi.
    1. Radikova Z. Assessment of insulin sensitivity/resistance in epidemiological studies. Endocr Regul. 2003;37:189–94.
    1. Monzillo LU, Hamdy O. Evaluation of insulin sensitivity in clinical practice and in research settings. Nutr Rev. 2003;61:397–412. doi: 10.1301/nr.2003.dec.397-412.
    1. Pacini G, Mari A. Methods for clinical assessment of insulin sensitivity and beta-cell function. Best Pract Res Clin Endocrinol Metab. 2003;17:305–22. doi: 10.1016/S1521-690X(03)00042-3.
    1. Radziuk J. Insulin sensitivity and its measurement: structural commonalities among the methods. J Clin Endocrinol Metab. 2000;85:4426–33. doi: 10.1210/jc.85.12.4426.
    1. Unwin N, Shaw J, Zimmet P, Alberti KG. Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabet Med. 2002;19:708–23. doi: 10.1046/j.1464-5491.2002.00835.x.
    1. Van Gaal LF, Peiffer F. New approaches for the management of patients with multiple cardiometabolic risk factors. J Endocrinol Invest. 2006;29:83–9.
    1. Wallace TM, Matthews DR. The assessment of insulin resistance in man. Diabet Med. 2002;19:527–34. doi: 10.1046/j.1464-5491.2002.00745.x.
    1. Lewanczuk RZ, Paty BW, Toth EL. Comparison of the [13C]glucose breath test to the hyperinsulinemic-euglycemic clamp when determining insulin resistance. Diabetes Care. 2004;27:441–7. doi: 10.2337/diacare.27.2.441.
    1. Lavine JE, Schwimmer JB. Nonalcoholic fatty liver disease in the pediatric population. Clin Liver Dis. 2004;8:549–58. doi: 10.1016/j.cld.2004.04.010. viii-ix.
    1. Mazzone T. Strategies in ongoing clinical trials to reduce cardiovascular disease in patients with diabetes mellitus and insulin resistance. Am J Cardiol. 2004;93:27C–31C. doi: 10.1016/j.amjcard.2004.02.003.
    1. Jawa A, Fonseca V. Cardiovascular effects of insulin sensitizers in diabetes. Curr Opin Investig Drugs. 2006;7:806–14.
    1. Younossi ZM. Review article: current management of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Aliment Pharmacol Ther. 2008;28:2–12.
    1. Yudkin JS. Insulin resistance and the metabolic syndrome--or the pitfalls of epidemiology. Diabetologia. 2007;50:1576–86. doi: 10.1007/s00125-007-0711-3.
    1. Petersen JL, McGuire DK. Impaired glucose tolerance and impaired fasting glucose--a review of diagnosis, clinical implications and management. Diab Vasc Dis Res. 2005;2:9–15. doi: 10.3132/dvdr.2005.007.

Source: PubMed

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