The Use of Areas Under Curves in Diabetes Research

Obesity Research Center, St. Luke's/Roosevelt Hospital, Columbia University College of Physicians and Surgeons, New York, New York 10025, USA.
Diabetes Care (Impact Factor: 8.42). 03/1995; 18(2):245-50. DOI: 10.2337/diacare.18.2.245
Source: PubMed

ABSTRACT Recently, several articles appearing in the diabetes literature have suggested that many investigators are unclear about a number of issues involving the use of areas under the curve (AUCs). This prompted us to reconsider issues in the calculation, use, meaning, and presentation of AUCs. We discuss five issues: 1) What is a curve and an area? 2) How should one graphically present a group's curve? 3) How should one calculate AUCs? 4) Should one subtract baseline values from outcome values before calculating AUCs? And 5) are AUCs the best way to combine multiple readings into a single index?

Download full-text


Available from: Xavier Pi-Sunyer, Dec 17, 2013
288 Reads
  • Source
    • "Glucose and insulin area under the curve (AUC) was determined using a trapezoid model (Allison et al. 1995). All participants stayed overnight at CHP to undergo the euglycemic clamp test the next morning. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We examined the joint and independent associations between VAT and LF with insulin sensitivity (IS) and lipids in seventy-one obese adolescents (BMI > 95th, 14.9 ± 1.8 years). VAT was assessed by magnetic resonance imaging and LF was quantified by proton magnetic resonance spectroscopy. IS was evaluated by a 3-hour hyperinsulinemic (80 mU/m2/min)-euglycemic clamp. Independent associations between VAT and LF on metabolic variables were assessed in mutually adjusted multivariate models. The joint association between VAT and LF on metabolic variables was assessed by categorizing participants into a low VAT + low LF group (n=35), high VAT + low LF group (n=26), or high VAT + high LF group (n=10) based on a VAT median split (1.17kg) and high (≥5%) and low (<5%) LF. Both VAT and LF were independently associated with fasting insulin, 2-hour insulin, insulin AUC, IS, and triglycerides (P<0.05). Adolescents with high VAT + high LF had higher 2-hour glucose, glucose AUC, 2-hour insulin, triglycerides, and lower insulin sensitivity compared to adolescents with high VAT only (P<0.025 for all). In obese adolescents, VAT and LF were independently associated with insulin sensitivity and dyslipidemia, and the concomitant presence of VAT and LF is strongly associated with metabolic risk factors.
    Biochemistry and Cell Biology 11/2014; DOI:10.1139/bcb-2014-0064 · 2.15 Impact Factor
  • Source
    • "Plasma C-peptide and glucose concentrations were used to determine the ISR in response to the oral glucose load and the sensitivity of the β-cell response (ISR) to changes in plasma glucose by using a minimal model (25). This model provides an estimate of the total amount of insulin secreted in response to plasma glucose as a function of time (i.e., total ISR in pmol/min) and partitions this total response into a dynamic component (ISRdynamic), which represents the rapid release of a readily releasable pool of insulin secretory granules in response to the rate of increasing plasma glucose concentration, and a static component (ISRstatic), which represents the slower release of a reserve pool of insulin secretory granules in response to the ambient plasma glucose concentration (28). "
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE Nonnutritive sweeteners (NNS), such as sucralose, have been reported to have metabolic effects in animal models. However, the relevance of these findings to human subjects is not clear. We evaluated the acute effects of sucralose ingestion on the metabolic response to an oral glucose load in obese subjects.RESEARCH DESIGN AND METHODS Seventeen obese subjects (BMI 42.3 ± 1.6 kg/m(2)) who did not use NNS and were insulin sensitive (based on a homeostasis model assessment of insulin resistance score ≤2.6) underwent a 5-h modified oral glucose tolerance test on two separate occasions preceded by consuming either sucralose (experimental condition) or water (control condition) 10 min before the glucose load in a randomized crossover design. Indices of β-cell function, insulin sensitivity (SI), and insulin clearance rates were estimated by using minimal models of glucose, insulin, and C-peptide kinetics.RESULTSCompared with the control condition, sucralose ingestion caused 1) a greater incremental increase in peak plasma glucose concentrations (4.2 ± 0.2 vs. 4.8 ± 0.3 mmol/L; P = 0.03), 2) a 20 ± 8% greater incremental increase in insulin area under the curve (AUC) (P < 0.03), 3) a 22 ± 7% greater peak insulin secretion rate (P < 0.02), 4) a 7 ± 4% decrease in insulin clearance (P = 0.04), and 5) a 23 ± 20% decrease in SI (P = 0.01). There were no significant differences between conditions in active glucagon-like peptide 1, glucose-dependent insulinotropic polypeptide, glucagon incremental AUC, or indices of the sensitivity of the β-cell response to glucose.CONCLUSIONS These data demonstrate that sucralose affects the glycemic and insulin responses to an oral glucose load in obese people who do not normally consume NNS.
    Diabetes care 04/2013; 36(9). DOI:10.2337/dc12-2221 · 8.42 Impact Factor
  • Source
    • "Plasma glucose was measured by the glucose oxidase method (YSI Stat Plus, Yellow Springs, OH, USA), insulin and C-peptide by double antibody radioimmunoassay (Linco Research). Total areas under the curve (AUCs) were calculated for the OGTT plasma glucose and insulin responses using the trapezoidal rule (Allison et al. 1995). Insulin resistance was calculated using homeostasis model assessment of insulin resistance {HOMA-IR = [fasting glucose (mmol/l) × fasting insulin (mIU/L)]/22.5} "
    [Show abstract] [Hide abstract]
    ABSTRACT: Calorie restriction (CR) slows aging and is thought to improve insulin sensitivity in laboratory animals. In contrast, decreased insulin signaling and/or mild insulin resistance paradoxically extends maximal lifespan in various genetic animal models of longevity. Nothing is known regarding the long-term effects of CR on glucose tolerance and insulin action in lean healthy humans. In this study we evaluated body composition, glucose, and insulin responses to an oral glucose tolerance test and serum adipokines levels in 28 volunteers, who had been eating a CR diet for an average of 6.9 +/- 5.5 years, (mean age 53.0 +/- 11 years), in 28 age-, sex-, and body fat-matched endurance runners (EX), and 28 age- and sex-matched sedentary controls eating Western diets (WD). We found that the CR and EX volunteers were significantly leaner than the WD volunteers. Insulin sensitivity, determined according to the HOMA-IR and the Matsuda and DeFronzo insulin sensitivity indexes, was significantly higher in the CR and EX groups than in the WD group (P = 0.001). Nonetheless, despite high serum adiponectin and low inflammation, approximately 40% of CR individuals exhibited an exaggerated hyperglycemic response to a glucose load. This impaired glucose tolerance is associated with lower circulating levels of IGF-1, total testosterone, and triiodothyronine, which are typical adaptations to life-extending CR in rodents.
    Age 11/2009; 32(1):97-108. DOI:10.1007/s11357-009-9118-z · 3.45 Impact Factor
Show more