BSPED2025 Oral Communications Diabetes Oral Communications 1 (5 abstracts)
A novel capillary-adjusted home oral glucose tolerance test: a practical and reliable alternative to the gold standard venous method in childhood early-stage type 1 diabetes
Rabbi Swaby 1 , Jacqueline Birks 2 , Colin Dayan 1,3 , Gareth Dunseath 4 , Kathleen Gillespie 5 , Yuk-Fun Liu 6,7 , Steve Luzio 4 , Ambika Shetty 8 , Rachel Williams 9 , Ruben H Willemsen 10 & Rachel E J Besser 1,11
1Diabetes and Inflammation Laboratory, Centre for Human Genetics, Nuffield Department of Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom; 2Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom; 3Clinical Diabetes and Metabolism, Cardiff University, School of Medicine, Cardiff, United Kingdom; 4College of Medicine, Swansea University, Swansea, United Kingdom; 5Diabetes and Metabolism Unit, Translational Health Sciences, University of Bristol, Bristol, United Kingdom; 6School of Life Course Sciences, King’s College London, London, United Kingdom; 7Diabetes Department, Guy’s and St Thomas NHS Foundation Trust, London, United Kingdom; 8The Noah’s Ark Children’s Hospital for Wales, Department of Paediatric Diabetes and Endocrinology, Cardiff and Vale University Health Board, Cardiff, United Kingdom; 9Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; 10The Royal London Children’s Hospital, Barts Health NHS Trust, Department of Paediatric Endocrinology and Diabetes, London, United Kingdom; 11Department of Paediatrics, University of Oxford, Oxford, United Kingdom
Objectives: The gold standard oral glucose tolerance test (OGTT) is used to stage and monitor disease progression in children and young people (CYP) with early-stage type 1 diabetes (T1D), but is poorly tolerated, contributing to high dropout rates during follow-up. We assessed a novel capillary OGTT device (cOGTT), which transforms capillary glucose measures to a venous equivalent, as an accurate and feasible alternative in CYP.
Method: We undertook two studies:
1. The cOGTT was assessed for a) agreement to venous glucose, using Bland-Altman, and b) its ability to classify standard glucose thresholds at fasting (5.6 mmol/l, 7.0 mmol/l), and 120-minutes (7.8 mmol/l, 11.1 mmol/l) during an in-hospital OGTT, (1.75g/kg glucose load, maximum 75g), in 31 CYP across the spectrum of glycaemia (normoglycaemia (n = 19), dysglycaemia (n = 6), hyperglycaemia (n = 6)), (mean age 12.2 years [SD 2.9], 48% male).2. Assessment of the feasibility and acceptability of the cOGTT in the home environment in 41 children with early-stage T1D. Acceptability was assessed by an age-appropriate questionnaire.
Results: Capillary glucose showed good agreement with venous glucose over the diagnostic range (3.5–15 mmol/l), with a small negative bias (-0.1 mmol/l, -2.47 to 2.31 mmol/l; absolute mean, 95% limits of agreement). Capillary glucose was highly correlated to venous glucose (Spearman’s Rho=0.83, P < 0.0001). At 0 minutes, cOGTT had 100% (1/1) sensitivity/ 96% (24/25) specificity to detect venous glucose of ≥5.6 mmol/l, and 75% (3/4) sensitivity/ 100% (26/26) specificity to detect venous glucose of ≥7.0 mmol/l. At 120 minutes, cOGTT had 50% (2/4) sensitivity/ 94% (17/18) specificity to detect venous glucose of ≥7.8 mmol/l, and 80% (4/5) sensitivity/ 100% (22/22) specificity to detect venous glucose of ≥11.1 mmol/l. Of those that responded (n = 30), 83% (25/30) chose the cOGTT device as their preferred method for future glycaemic assessment. Ninety-percent (37/41) of cOGTT were successfully completed in the home setting. Ten-percent (4/41) of cOGTT were unsuccessful, 7.5% (3/41) due to device failures, 2.5% (1/41) due to participant issues. Ninety-eight percent (40/41) found completing the test at home acceptable.
Conclusions: The cOGTT device is a highly specific and acceptable alternative to venous sampling. The cOGTT offers a practical alternative to the standard in-hospital OGTT with the potential to improve adherence to testing.
Volume 111
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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