Outpatient versus inpatient mixed meal tolerance and arginine stimulation testing yields comparable measures of variability for assessment of beta cell function

Abstract

Standard practice to minimize variability in beta cell function (BCF) measurement is to test in inpatient (IP) settings. IP testing strains trial subjects, investigators, and budgets. Outpatient (OP) testing may be a solution although there are few reports on OP BCF testing variability. We compared variability metrics between OP and IP from a standardized mixed meal tolerance test (MMTT) and arginine stimulation test (AST) in two separate type 2 diabetes (T2DM) cohorts (OP, n = 20; IP n = 22) in test-retest design. MMTT variables included: insulin sensitivity (Si); beta cell responsivity (Φtot); and disposition index (DItot = Si* Φtot) following 470 kCal meal. AST variables included: acute insulin response to arginine (AIRarg) and during hyperglycemia (AIRargMAX).ResultsBaseline characteristics were well-matched. Between and within subject variance for each parameter across cohorts, and intraclass correlation coefficients (ICC-a measure of reproducibility) across parameters were generally comparable for OP to IP. Table summarizes the ICC results for each key parameter and cohort.Test/ParameterOutpatient (95% CI)Inpatient (95% CI)MMTT: Si0.49(0,0.69)0.28(0,0.60)MMTT: Φtot0.65(0.16,0.89)0.81(0.44,0.93)MMTT: DI0.67(0,0.83)0.36(0,0.69) AST: AIR Arg0.96(0.88,0.98)0.84(0.59,0.94)AST: AIR Arg Max0.97(0.90,0.99)0.95(0.86,0.97)AST: ISR0.93(0.77,0.97)0.93(0.82,0.96)In conclusion, the variability (reproducibility) of BCF measures from standardized MMTT and AST is comparable between OP and IP settings. These observations have significant implications for complexity and cost of metabolic studies.

Evaluating Insulin/Glucose Ratio Using Breakfast of Calorie Restriction Meal for Type 2 Diabetes Mellitus

“…For MMT, several reports were found in the clinical study for breakfast. One is a standardized mixed meal tolerance test (MMTT) for assessment of the ability of beta cell of the pancreas [32].…”