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Standardization of IVGTT to predict IDDM
P J Bingley1, P Colman, G S Eisenbarth
1Department of Diabetes and Metabolism, St. Bartholomew's Hospital, London, United Kingdom.
Diabetes Care
|October 1, 1992
Summary
The intravenous glucose tolerance test (IVGTT) is used to predict insulin-dependent diabetes mellitus (IDDM). Wide variations in IVGTT methodology were found, leading to a new consensus protocol for improved IDDM risk prediction.
Area of Science:
- Endocrinology
- Metabolic Research
- Diabetes Mellitus Research
Background:
- The first-phase insulin response during the intravenous glucose tolerance test (IVGTT) is a key indicator for predicting the progression to insulin-dependent diabetes mellitus (IDDM).
- Current practices in performing the IVGTT vary significantly across different research centers.
Purpose of the Study:
- To review existing practices for IVGTT in centers utilizing this test for IDDM prediction.
- To establish a standardized consensus protocol for the accurate and reproducible performance of the IVGTT.
Main Methods:
- A postal questionnaire was distributed to 12 centers involved in IVGTT testing.
- Data collected focused on glucose dosage, infusate concentration, injection method, infusion duration, and timing of blood sampling.
Main Results:
- Significant variability was observed in glucose dosage (0.3-0.5 g/kg, with varied adult limits), infusate concentration (20-66%), injection methods (manual, syringe pump, gravity), infusion duration (30s to 4min), and blood sampling time points.
- Inconsistent quality-assurance standards for insulin assays were noted, particularly for fasting and low stimulated insulin levels.
Conclusions:
- The methodology for the IVGTT used in predicting IDDM risk is highly variable.
- A new standard protocol for IVGTT has been agreed upon by an ICARUS working group to improve the reliability of IDDM prediction.