Intravenous Glucose Tolerance Tests in Predicting Diabetes Onset in APECED: A Retrospective Cohort Study

Figures

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  Figure 1.. Flowchart of the study participant selection. APECED, autoimmune polyendocrinopathy candidiasis ectodermal dystrophy; IVGTT, intravenous glucose tolerance test; DM, diabetes mellitus; DM+, patients who developed DM during the follow-up period; DM−, patients who did not develop DM during the follow-up period.

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  Figure 2.. Mean circulating glucose concentrations (±SD) in 13 patients with autoimmune polyendocrinopathy candidiasis ectodermal dystrophy prior to diabetes mellitus (DM) diagnosis. Different colors and symbols are used to indicate the time interval between the intravenous glucose tolerance test (IVGTT) and diagnosis of DM. Mean circulating glucose concentrations at different time intervals to DM diagnosis are depicted in A to E: A, less than 1 year; B, 1 to 2 years; C, 3 to 5 years; D, 6 to 10 years; and E, more than 10 years prior to diagnosis; and all together in F. The letter n is used to denote the number of patients per different time interval category.

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  Figure 3.. Mean circulating insulin concentrations (±SD) in 10 patients with autoimmune polyendocrinopathy candidiasis ectodermal dystrophy prior to diabetes mellitus (DM) diagnosis. Different colors and symbols are used to indicate the time interval between the intravenous glucose tolerance test (IVGTT) and diagnosis of DM. Mean circulating insulin concentrations at different time intervals to DM diagnosis are depicted in A to E: A, less than 1 year; B, 1 to 2 years; C, 3 to 5 years; D, 6 to 10 years; and E, more than 10 years prior to diagnosis; and all together in F. The letter n denotes the number of patients per different time interval category.

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  Figure 4.. A, median baseline fasting plasma glucose (FPG); B, median baseline fasting plasma insulin (INS) in patients ages younger than 20 years and 20 to 40 years with autoimmune polyendocrinopathy candidiasis ectodermal dystrophy who developed diabetes mellitus (gray boxes, n = 13) in comparison to those who did not (empty boxes, n = 44). Each box represents the interquartile range, and horizontal line within each box indicates the median value. Whiskers depict values 1.5 times the interquartile range from quartile (Q1) and Q3. ***, 2-sided P value less than .001; ns, statistically nonsignificant.

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  Figure 5.. A, fractional glucose removal (KG) rate in 13 patients with autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED) prior the diagnosis of diabetes mellitus (DM) (r = −0.568; P < .0001); B, KG in relation to age at intravenous glucose tolerance testing (IVGTT) in 13 APECED patients with DM (DM+) and 44 APECED patients without DM (DM−), (DM+, r = −0.393; P < .01; DM−, r = −0.277; P < .001); C, first-phase insulin response (FPIR) rate in 9 patients with APECED prior to DM− diagnosis (rs = −0.730; P < .001); D, FPIR in relation to age at IVGTT in 9 DM+ patients and 38 DM− patients (DM+, rs = −0.588, <.001; DM−, rs = −0.217; P = .042). The letter n denotes the number of IVGTT measurements for DM− and DM+ groups. r, Pearson correlation coefficient; rs, Spearman rank correlation coefficient.

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  Figure 6.. Homeostatic model assessment 1 (HOMA1) and interactive homeostatic model assessment 2 (iHOMA2) indices for insulin resistance A (HOMA1-IR); insulin sensitivity B (iHOMA-2%S); and β-cell function C (HOMA1-%B) and D (iHOMA-2%B) in relation to the age of autoimmune polyendocrinopathy candidiasis ectodermal dystrophy patient with diagnosis of diabetes mellitus (DM) in the future (n = 13, black dots) or no DM (n = 44, gray dots).