The Shape of the Oral Glucose Tolerance Test-Glucose Response Curve in Islet Cell Antibody-Positive vs. -Negative Obese Youth Clinically Diagnosed with Type 2 Diabetes

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Background: The oral glucose tolerance test (OGTT)-glucose response curves (GRCs; incessant increase, monophasic, and biphasic) reflect insulin sensitivity and β-cell function, being worse in the former and superior in the latter.Here, we examined if the OGTT-GRC pattern is worse in obese antibody (glutamic acid decarboxylase 65-kDa [GAD65] and insulinoma-associated protein-2 [IA-2])-positive (Ab + ) vs. -negative (Ab -) youth clinically diagnosed with type 2 diabetes (CDX-T2D).Methods: Forty-seven obese youth, 15 Ab + and 32 Ab -, were divided into three OGTT-GRC groups: incessant increase, monophasic, and biphasic.The prevalence of OGTT-GRC, clamp-measured insulin sensitivity, and β-cell function was compared.Results: Incessant increase OGTT-GRC is the most frequent curve type and is three-fold higher in Ab + vs. Ab - youth CDX-T2D.In Ab + youth, there was up to 40% lower second-phase insulin secretion in the incessant increase group vs. the other two groups combined (monophasic and biphasic).In Ab -youth, while first-and second-phase insulin secretion was significantly lower in the incessant increase vs. the other two groups combined, overall β-cell function was less impaired than in Ab + youth.In neither Ab -or Ab + youth was OGTT-GRC related to hepatic or peripheral insulin sensitivity.Conclusion: Severe insulin deficiency, a characteristic of type 1 diabetes, seems to be related to higher prevalence of incessant increase in Ab + vs. Ab -obese youth.

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