“Ogtt-Plus” – A Novel Web-App for Model Assessment of Cardio-Vascular Risk in Obesity, Dysmetabolism & Dysglycemia

• Published in: The American heart journal Vol. 254; p. 241
• Main Authors: Shinde, Suresh N., Shinde, Rituparna S., Joshi, Ashwini S.
• Format: Journal Article
• Language: English
• Published: Philadelphia Elsevier Inc 01-12-2022; Elsevier Limited
• Subjects: Beta cells; Diabetes; Diabetes mellitus; Discordance; Dyslipidemia; Glucose; Hyperglycemia; Hyperinsulinemia; Hypertension; Insulin; Insulin resistance; Insulin secretion; Microvasculature; Morbidity; Obesity; Risk analysis; Secretion
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2022.10.027

We developed this web based ‘Dysmetabolism-Risk Calculator’ after analysing 1800 individuals, who underwent ‘standard two hour 75 gram OGTT’ along with insulin levels. It calculates the basal and post-glucose indexes of insulin secretion (ISec), insulin resistance (IRes) and beta cell function (BCF), based on areas under the curve of both glucose (AUCg) and insulin (AUCi). It generates dynamic graphs of glucose and insulin along with population-norm values and determines various stages of dys-insulinemia, obesity, and diabetes. On the dysmetabolism time-line, ‘Euglycemic Hyperinsulinemia’ and ‘Midzone Hyperglycemia’, are specially important categories. These categories, characteristically, occur before ‘Prediabetes’ stage, (Pre-Prediabetes), and are known to be associated with increased cardio-vascular morbidity such as hypertension, dyslipidemia, endothelial dysfunction, and stroke. IRes is calculated using “AUCg*AUCi*k” formula. ISec and central IRes is calculated by measuring ‘rate of rise of insulin’ and the angle theta, which is subtended by the 30 min insulin curve with ‘x’ axis. Insulin disposal and peripheral IRes is determined by calculating angle zeta which is subtended by the 90-120 min insulin curve with ‘y’ axis. Disposition index (Isec*Ires*k) is calculated by the formula “1/(AUCg) 2”, which, noticeably, is independent of AUCi. The discordance between Insulin Secretion Index and OGTT Disposition Index will be useful in predicting the reversibility of diabetes and dysmetabolism. BMI, 0-30 & 90-120 min AUCis are used as parameters, while calculating the probable site of ‘Tissue IRes’. Cardio-Vascular risk calculations are based on hyperinsulinemia (as macrovascular risk), hyperglycemia (as microvascular risk), and their combination as they occur on dysmetabolism time-time.