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Glucotypes reveal new patterns of glucose dysregulation
Heather Hall, Dalia Perelman, Alessandra Breschi, Patricia Limcaoco, Ryan Kellogg, Tracey McLaughlin, Michael Snyder

Kurzes Zitat:
It is interesting to note that CGM severity correlates with OGTT, but they are not identical, and a number of individuals with normal OGTT responses exhibited severe glucose variability. In a different study, Maaze and colleagues reported similar results (23). The difference in OGTT measurements, which relies on pure glucose, as compared with CGM may be due to several possibilities. First, current measures are limited by the OGTT measure itself, which relies on two glucose values obtained on a single day, which fails to capture sufficient data to identify individuals at early states of glucose dysregulation. Second, it is possible that specific foods, amounts, and mechanisms of glucose delivery and removal to individuals cause greater glucose elevation in natural setting than delivery of pure glucose. These possibilities are not mutually exclusive. Regardless, our proposed glycemic variability metric has the advantage of classifying individuals into risk categories more accurately and in a more natural environment than current clinical tests. Having individuals use a wearable device to examine glucose response outside of the clinic in their normal environment provided more granular information than the snapshot of clinical phenotypes typically used. Importantly, 9 out of the 23 individuals classified as glucotypes S would not be diagnosed with prediabetes or diabetes using the traditional diagnostic tests of fasting blood sugars, 2-hour OGTT, or HbA1C. These individuals could start lifestyle modifications that would reduce their risk of developing disease at a much earlier stage. For example, the three individuals in Eig 60. 6E and 6F had a BMI in the overweight range, suggesting that glucotype classification can help identify subjects with altered glucose homeostasis resulting from diverse metabolic phenotypes, for which weight loss interventions might be beneficial. Based on our results with the standardized meals, these individuals would be able to lower the glucose variability by decreasing carbohydrate load and choosing more complex carbohydrates and including protein in their meals. Importantly, since different people respond differently to the same meals (a result noted by Zeevi and colleagues (11)), it should be possible to personalize dietary programs and thereby manage glucose elevations at an individual level, CGM will be valuable for this purpose.

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Es gibt keine organisch oder physiologisch erkennbaren Anfangspunkte. Deswegen sind Prädiabetes und vor allem Diabetes Typ 2 und die Diagnose-Grenzwerte von den Fachgesellschaften für Diabetes definiert.