Introduction The shape of the glucose curve during an oral glucose tolerance test (OGTT) reflects β-cell function in populations without diabetes but has not been as well studied in those with diabetes. A monophasic shape has been associated with higher risk of diabetes, while a biphasic pattern has been associated with lower risk. We sought to determine if phenotypic or metabolic characteristics were associated with glucose response curve shape in adults with type 2 diabetes treated with metformin alone. Research design and methods This is a cross-sectional analysis of 3108 metformin-treated adults with type 2 diabetes diagnosed <10 years who underwent 2-hour 75 g OGTT at baseline as part of the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Insulin sensitivity (homeostasis model of insulin sensitivity, HOMA2-S) and β-cell function (early, late, and total incremental insulin and C peptide responses adjusted for HOMA2-S) were calculated. Glucose curve shape was classified as monophasic, biphasic, or continuous rise. Results The monophasic profile was the most common (67.8% monophasic, 5.5% biphasic, 26.7% continuous rise). The monophasic subgroup was younger, more likely male and white, and had higher body mass index (BMI), while the continuous rise subgroup was more likely female and African American/black. HOMA2-S and fasting glucose did not differ among the subgroups. The biphasic subgroup had the highest early, late, and total insulin and C peptide responses (all p<0.05 vs monophasic and continuous rise). Compared with the monophasic subgroup, the continuous rise subgroup had similar early insulin (p=0.3) and C peptide (p=0.6) responses but lower late insulin (p<0.001) and total insulin (p=0.008) and C peptide (p<0.001) responses. Conclusions Based on the large multiethnic GRADE cohort, sex, race, age, and BMI were found to be important determinants of the shape of the glucose response curve. A pattern of a continuously rising glucose at 2 hours reflected reduced β-cell function and may portend increased glycemic failure rates. Trial registration number [NCT01794143][1]. The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) is being conducted with funding from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). This manuscript is based on the baseline (pretreatment) data from the 5047 participants enrolled into the study. These baseline data will be archived with the NIDDK data repository and will be available for sharing with other investigators upon publication. In accordance with the NIH Public Access Policy, we continue to provide all manuscripts to PubMed Central including this manuscript. GRADE has provided the protocols to the public through its public website (). GRADE abides by the NIDDK data sharing policy and implementation guidance as required by the NIH/NIDDK (). [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01794143&atom=%2Fbmjdrc%2F9%2F1%2Fe002264.atom

中文翻译：

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OGTT 葡萄糖反应曲线的形状：二甲双胍治疗的早期 2 型糖尿病成人与 β 细胞功能的关系以及性别、种族和 BMI 的差异

简介 口服葡萄糖耐量试验 (OGTT) 期间葡萄糖曲线的形状反映了非糖尿病人群中的 β 细胞功能，但尚未在糖尿病人群中得到充分研究。单相形状与较高的糖尿病风险相关，而双相模式与较低的风险相关。我们试图确定表型或代谢特征是否与单独使用二甲双胍治疗的 2 型糖尿病成人的葡萄糖反应曲线形状相关。研究设计和方法 这是对 3108 名诊断为 <10 岁且接受二甲双胍治疗的 2 型糖尿病成人的横断面分析，他们在基线时接受了 2 小时 75 克 OGTT，作为糖尿病血糖降低方法的一部分：一项比较有效性研究（年级）。胰岛素敏感性（胰岛素敏感性稳态模型，计算 HOMA2-S) 和 β 细胞功能（针对 HOMA2-S 调整的早期、晚期和总增量胰岛素和 C 肽反应）。葡萄糖曲线形状分为单相、双相或连续上升。结果单相分布最常见（67.8% 单相，5.5% 双相，26.7% 连续上升）。单相亚组更年轻，更可能是男性和白人，并且具有更高的体重指数 (BMI)，而持续上升亚组更可能是女性和非裔美国人/黑人。HOMA2-S 和空腹血糖在亚组之间没有差异。双相亚组具有最高的早期、晚期和总胰岛素和 C 肽反应（所有 p < 0.05 与单相和持续上升相比）。与单相亚组相比，持续上升亚组具有相似的早期胰岛素 (p=0.3) 和 C 肽 (p=0. 6) 反应但较低的晚期胰岛素 (p<0.001) 和总胰岛素 (p=0.008) 和 C 肽 (p<0.001) 反应。结论 基于大型多种族 GRADE 队列，发现性别、种族、年龄和 BMI 是葡萄糖反应曲线形状的重要决定因素。2 小时内血糖持续升高的模式反映了 β 细胞功能下降，可能预示着血糖失败率增加。试用注册号[NCT01794143][1]。在美国国家糖尿病和消化及肾脏疾病研究所 (NIDDK) 的资助下，糖尿病患者的血糖降低方法：一项比较有效性研究 (GRADE) 正在开展。本手稿基于参加研究的 5047 名参与者的基线（治疗前）数据。这些基线数据将与 NIDDK 数据存储库一起存档，并可在发布后与其他研究人员共享。根据 NIH 公共访问政策，我们继续向 PubMed Central 提供所有手稿，包括本手稿。GRADE 通过其公共网站 (). GRADE 遵守 NIDDK 数据共享政策和实施指南，如 NIH/NIDDK 所要求（). [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01794143&atom=%2Fbmjdrc%2F9%2F1%2Fe002264.atom