Evaluation of a novel non‐invasive 13C‐glucose breath test for the identification of diabetes mellitus in cirrhotic patients

Abstract

Diabetes mellitus (DM) has been reported to worsen the long-term prognosis of cirrhotic patients, and many studies have reported that DM is an independent risk factor for hepatocellular carcinoma. However, an accurate diagnosis of DM is sometimes difficult in cirrhotic patients. Recently, a novel non-invasive (13) C-glucose breath test has been reported to be useful for diagnosing insulin resistance in non-cirrhotic patients. The aim of this study was to evaluate the efficacy of this tool for the identification of DM in cirrhotic patients. Thirty eight cirrhotic patients with normal fasting serum glucose and hemoglobin A1c levels underwent the (13) C-glucose breath test and the oral glucose tolerance test. Blood and breath samples were collected at baseline and at 30, 60 and 120 min after ingestion of 100 mg (13) C-labeled glucose and 75 g glucose. There was a strong correlation between the change in the concentrations at 2 h for the measured (13) C-glucose breath test (2h-BT) and the 2 h plasma glucose level (r = -0.60, P < 0.0001). In a receiver-operator curve analysis using the 2h-BT, the area under the curve was determined to be 0.88, with a sensitivity and specificity (cut-off value of 3.5‰) of 82% and 85%, respectively, for the detection of DM. Multivariate analysis showed the 2h-BT to be an independent parameter to identify DM. The (13) C-glucose breath test is a useful tool and has the potential to become a routine outpatient examination for the screening of DM in cirrhotic patients.