The 13C-Glucose Breath Test for Insulin Resistance Assessment in Adolescents: Comparison with Fasting and Post-Glucose Stimulus Surrogate Markers of Insulin Resistance

Jorge Maldonado-Hernández, Azucena Martínez-Basila, Alejandra Salas-Fernández, José R Navarro-Betancourt, Mónica I Piña-Aguero, Mariela Bernabe-García, Jorge Maldonado-Hernández, Azucena Martínez-Basila, Alejandra Salas-Fernández, José R Navarro-Betancourt, Mónica I Piña-Aguero, Mariela Bernabe-García

Abstract

Objective: To evaluate the use of the 13C-glucose breath test (13C-GBT) for insulin resistance (IR) detection in adolescents through comparison with fasting and post-glucose stimulus surrogates.

Methods: One hundred thirty-three adolescents aged between 10 and 16 years received an oral glucose load of 1.75 g per kg of body weight dissolved in 150 mL of water followed by an oral dose of 1.5 mg/kg of U-13C-Glucose, without a specific maximum dose. Blood samples were drawn at baseline and 120 minutes, while breath samples were obtained at baseline and at 30, 60, 90, 120, 150, and 180 minutes. The 13C-GBT was compared to homeostasis model assessment (HOMA) IR (≥p95 adjusted by gender and age), fasting plasma insulin (≥p90 adjusted by gender and Tanner stage), results of 2-h oral glucose tolerance test (OGTT), insulin levels (≥65 μU/mL) in order to determine the optimal cut-off point for IR diagnosis.

Results: 13C-GBT data, expressed as adjusted cumulative percentage of oxidized dose (A% OD), correlated inversely with fasting and post-load IR surrogates. Sexual development alters A% OD results, therefore individuals were stratified into pubescent and post-pubescent. The optimal cut-off point for the 13C-GBT in pubescent individuals was 16.3% (sensitivity=82.8% & specificity=60.6%) and 13.0% in post-pubescents (sensitivity=87.5% & specificity=63.6%), when compared to fasting plasma insulin. Similar results were observed against HOMA and 2-h OGTT insulin.

Conclusion: The 13C-GBT is a practical and non-invasive method to screen for IR in adolescents with reasonable sensitivity and specificity.

Conflict of interest statement

Financial Disclosure: This study was supported with a grant from Consejo Nacional de Ciencia y Tecnología de México (CONACYT), registry number: SALUD-2010-01-139180.

Figures

Figure 1. Receiver operating characteristic curves evaluating…
Figure 1. Receiver operating characteristic curves evaluating the sensitivitiy and specificity of the 13C-glucose breath test using different criteria to define insulin resistance. A-C: Performance in pubescent individuals. D-C: Performance in post-pubescent individuals. A, D= HOMA-IR ≥p95 reference score; B, E= fasting plasma insulin ≥p90 reference score; C, F: plasma insulin at the 2-hour time point of an oral glucose tolerance test ≥65 μU/mL

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