Serum alpha-hydroxybutyrate (alpha-HB) predicts elevated 1 h glucose levels and early-phase beta-cell dysfunction during OGTT.

  • Varvel S
  • Pottala J
  • Thiselton D
 et al. 
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Abstract

OBJECTIVE: Serum alpha-hydroxybutyrate (alpha-HB) is elevated in insulin resistance and diabetes. We tested the hypothesis that the alpha-HB level predicts abnormal 1 h glucose levels and beta-cell dysfunction inferred from plasma insulin kinetics during a 75 g oral glucose tolerance test (OGTT). RESEARCH DESIGN AND METHODS: This cross-sectional study included 217 patients at increased risk for diabetes. 75 g OGTTs were performed with multiple postload glucose and insulin measurements over a 30-120 min period. OGTT responses were analyzed by repeated measures analysis of variance (ANOVA). Multivariable logistic regression was used to predict 1 h glucose >/=155 mg/dL with alpha-HB added to traditional risk factors. RESULTS: Mean+/-SD age was 51+/-15 years (44% male, 25% with impaired glucose tolerance). Fasting glucose and insulin levels, but not age or body mass index (BMI), were significantly higher in the second/third alpha-HB tertiles (>3.9 microg/mL) than in the first tertile. Patients in the second/third alpha-HB tertiles exhibited a higher glucose area under the receiver operating characteristics curve (AUC) and reduced initial slope of insulin response during OGTT. The AUC for predicting 1 h glucose >/=155 mg/dL was 0.82 for a base model that included age, gender, BMI, fasting glucose, glycated hemoglobin (HbA1c), and insulin, and increased to 0.86 with alpha-HB added (p=0.015), with a net reclassification index of 52% (p

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Authors

  • Stephen A Varvel

  • James V Pottala

  • Dawn L Thiselton

  • Rebecca Caffrey

  • Tara Dall

  • Maciek Sasinowski

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