Oral glucose tolerance test clearance in type 2 diabetes patients who underwent remission following intense lifestyle modification: A quasi-experimental study

Achieving diabetes remission (HbA1c<48mmol/mol without the use of anti-diabetic medication for 3 months) might not assure restoration of a normal glycemic profile [fasting blood sugar level <5.6 mmol/L and Post-Prandial (PP) blood glucose <7.8mmol/L]. The study investigates the factors associated with OGTT clearance in patients under type 2 diabetes remission. Four hundred participants who achieved remission during a one-year online structured lifestyle modification program, which included a plant-based diet, physical activity, psychological support, and medical management (between January 2021 and June 2022), and appeared for the OGTT were included in the study. OGTT clearance was defined by fasting blood glucose < 5.6 mmol/L and 2-hour post-prandial blood glucose <7.8 mmol/L post-consumption of 75g glucose solution. Of the 400 participants, 207 (52%) cleared OGTT and 175 (44%) had impaired glucose tolerance (IGT). A shorter diabetes duration (<5 years) was significantly associated with OGTT clearance (p<0.05). Pre-intervention use of glucose-lowering drugs showed no association with OGTT clearance (p<0.1). Post-intervention, the OGTT-cleared group showed significantly higher weight loss (p<0.05) and a decrease in HbA1c compared to the IGT group (p<0.05). Improvement in Insulin resistance and β-cell function was also higher in the OGTT-cleared group compared to the IGT group (p<0.05). In conclusion, clearing the OGTT is a possibility for those achieving remission through lifestyle interventions. Higher weight loss, a shorter duration of diabetes, and improvement in insulin resistance were significantly associated with OGTT clearance in participants in remission. Future randomized controlled trials with longer follow-ups may help substantiate our findings.

Can serum autoantibodies be a potential early detection biomarker for breast cancer in women? A diagnostic test accuracy review and meta-analysis

BACKGROUND

The increasing incidence of breast cancer necessitates the need to explore alternate screening strategies that circumvent the setbacks of conventional techniques especially among population that report earlier age at diagnosis. Serum autoantibodies is one such potential area of interest. However, their ubiquitous presence across cancer types limits its applicability to any one specific type of cancer. This review was therefore carried out to explore and consolidate available evidence on autoantibodies for early detection of breast cancer and to identify those that demonstrated a higher sensitivity.

METHODS

A diagnostic test accuracy (DTA) review was carried out to ascertain serum autoantibodies that could be used for early detection of breast cancer among women. All relevant articles that investigated the role of autoantibodies in early detection of breast cancer were included for the review. MEDLINE, Scopus, ProQuest, Ovid SP, and Cochrane Library were searched extensively for eligible studies. Quality of the included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. RevMan 5.3 was used for exploratory and MetaDTA 2019 for hierarchical analyses. The review helped identify the most frequently investigated autoantibodies and a meta-analysis further consolidated the findings.

RESULTS

A total of 53 articles were included for the final analysis that reported over a 100 autoantibodies that were studied for early detection of breast cancer in women. P53, MUC1, HER2, HSP60, P16, Cyclin B1, and c-Myc were the most frequently investigated autoantibodies. Of these P53, MUC1, HER2, and HSP60 exhibited higher summary sensitivity measures. While the individual pooled sensitivity estimates ranged between 10 and 56%, the panel sensitivity values reported across studies were higher with an estimated range of 60-87%.

CONCLUSION

Findings from the review indicate a higher sensitivity for an autoantibody panel in comparison to individual assays. A panel comprising of P53, MUC1, HER2, and HSP60 autoantibodies has the potential to be investigated as an early detection biomarker for breast cancer.

Abstract P1-01-01: Clinical efficacy evaluation of a novel palpation imaging device for early detection of breast cancer in the developing world

Background & Objectives: Breast cancer is the most common cancer in women worldwide, disproportionately affecting low- and-middle income countries (LMICs). 52.6% of new breast cancer cases occur in LMICs, and this is expected to grow to 70% by year 2020. Two-thirds of the estimated 15,000,000 healthy-life years lost annually to breast cancer globally are from LMICs. The 5-year survival rate is 40-60% in most LMICs as compared to 80-90% in High Income Countries (HICs). Low-cost, user-friendly technology can help equip minimally trained community health workers to administer standardized breast exams without any special infrastructure, with the goal to down-stage breast cancer.

Methods: IRB cleared prospective trial enrolled women as part of a community screening program or women seeking medical advice for breast related symptoms. Consenting women above age 30 were eligible to enroll. Subjects received an iBreastExam evaluation and a Clinical Breast Examination (CBE), each by a different health-worker, blinded to the other test. Subjects positive on iBE and/or CBE, received follow-up diagnostic imaging (mammogram for women above age 40 years or breast ultrasound for women age 40 years or younger). Standard of truth was established as a positive mammogram BIRADS 3-6 or a positive ultrasound as BIRADS 3-6. To assess accuracy of iBE and CBE to detect lesions, the sensitivity and specificity were calculated compared to diagnostic imaging. For the purposes of analysis, each breast was considered as an independent result. Instead of detection of cancer, standardized diagnostic imaging modalities (mammogram and ultrasound) were used as comparators because the palpation device was evaluated as a tool in LMIC settings to enable early detection of suspicious breast lumps requiring clinical follow-up.

Results: 1,200 women (2,400 breasts) with median age of 43 years were examined under this study with both, iBE and CBE. From 2,400 breasts, 96 were identified by iBreastExam, CBE or both to have at least one breast lesion. An additional 63 women (126 breasts) enrolled in the study due to a breast related symptom and were examined with iBE, CBE and age-appropriate diagnostic imaging. Combining both groups, 222 breasts were examined with age-appropriate diagnostic imaging. Compared to diagnostic imaging, the sensitivity, specificity, Negative Predictive Value and Positive Predictive Value of iBE is 86%, 91%, 98%, 57%, respectively. Compared to diagnostic imaging, the sensitivity, specificity, Negative Predictive Value and Positive Predictive Value of CBE is 63%, 82%, 94%, 32%, respectively.

Conclusions: Compared to Clinical Breast Exam, iBreastExam demonstrated significantly (23%) higher sensitivity and moderately (9%) higher specificity to detect breast lesions. Given that iBE requires minimal training and provides objective breast examination with digital documentation; better performance than clinical exam highlights the tools’ utility as a triaging tool by identifying women in need for follow-up diagnostics. iBreastExam may enable community health worker led triaging to detect clinically relevant breast lesions in LMIC settings.

Citation Format: Suma Nair, Thejas Kathrikolly, PU Prakash Saxena. Clinical efficacy evaluation of a novel palpation imaging device for early detection of breast cancer in the developing world [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-01-01.