Clinical application of arginine stimulation test in individuals with different glucose tolerance

ZHAO Jing; YIN Jiangning; PENG Yigen

doi:10.3969/j.issn.1002-7386.2024.24.010

Abstract：Objective To investigate the changes in islet β-cell function in individuals with different glucose tolerance during the arginine stimulation test(AST)and to establish the cut-off points for guiding the insulin treatment in patients with type 2 diabetes mellitus(T2DM).Methods A total of 120 diabetic patients and healthy people admitted from January 2018 to January 2020 were included,involving 22 subjects with normal glucose tolerance(NGT group),17 subjects with impaired glucose tolerance(IGT group),21 T2DM patients only treated with oral hypoglycemic agents(T2DMa group),30 T2DM patients treated with insulin(T2DMb group)and 30 subjects with type 1 diabetes mellitus(T1DM group).All of them were received AST.Plasma glucose(PG),insulin(INS)and C-peptide(CP)concentrations at 0,2,4 and 6min were measured.Results Fasting INS/PG,CP/PG in T2DMb and T1DM groups were significantly lower than those of the NGT group(P＜0.05),and they were significantly lower in the T2DMb group than the T2DMa group(P＜0.05).INS/PG and CP/PG in all groups reached the peak at 2 min.The peak/baseline ratio of INS/PG in T2DMa,T2DMb and T1DM groups was significantly lower than that of the NGT group(P＜0.05),and it was significantly lower in the T1DM group than the IGT group(P＜0.05).Compared with NGT group,T2DMa,T2DMb and T1DM groups had significantly lower INS/PG and INS/PG at 2,4,and 6min,and those in T2DMb and T1DM groups were significantly lower than IGT and T2DMa groups(P＜0.05).T2DMb and T1 DM group had significantly lower △INS,△CP,△INS/PG,△CP/PG,AUCINS(insulin area under the curve),AUCCP(C-peptide area under the curve),AUCINS/PG and AUCCP/PG than NGT,IGT and T2DMa groups(P＜0.05).IGT,T2DMb and T1DM groups had significantly lower homeostatic model assessment for beta-cell function(HOMA-β)than the NGT group(P＜0.05).The optimal cut-off points of AUCCP/PG and AUCCP for guiding insulin treatment in T2DM patients were 164.0 and 5995.1,respectively.Conclusion The arginine stimulation test can be used to estimate β-cell function in individuals with different glucose tolerance.△INS,△INS/PG,AUCINS/PG and AUCCP/PG appear to be more valuable in the evaluation of islets β-cell function.The arginine stimulation test can effectively guide the time point of insulin treatment in T2DM patients,especially the indicators of AUCCP/PG and AUCCP.