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T2D Better Diagnosed Using One-Hour Post-Load Hyperglycemia

Study shows that impaired fasting glucose is less accurate diagnostic tool…

 

Patients with normal glucose tolerance (NGT) and 1-hour post-load plasma glucose level of ≥155 mg/dl have a higher cardio-metabolic risk profile compared to patients with NGT and impaired glucose tolerance (IGT), according to The Journal of Clinical Endocrinology & Metabolism.

The purpose of this study was to examine whether patients with NGT-1h-high had a dissimilarity in cardio-metabolic characteristics and an increased risk of type 2 diabetes as compared to patients with isolated impaired fasting glucose (IFG).

In an ambulatory care setting, a cross-sectional analysis was performed on 595 non-diabetic patients; an oral glucose tolerance test and an euglycemic hyperinsulinemic clamp were used. Also, a longitudinal analysis was performed on 392 patients, and they were re-examined after 5.2 years. The main outcomes measured insulin sensitivity, beta-cell function and risk of developing diabetes.

Disposition index measured peripheral insulin sensitivity and beta-cell function found a remarkable reduction in patients with NGT-1h-high, however, not with NGT-1h-low or IFG patients. In the longitudinal analysis, type 2 diabetes patients had a percent incidence rate of 2.9 (NGT-1h-low), 16.7(NGT-1h-high), 12.5(IFG), and 31.4(IGT). In a Cox proportional hazard regression analysis, patients with IGT had a higher risk of 6.67 of developing diabetes compared with NGT 1h-high patients was 4.02, and the lowest rate was 1.91 in isolated IFG group.

“NGT-1h-high subjects exhibit a higher risk of developing diabetes than those with IFG or NGT-1h-low, likely due to decreased insulin sensitivity and beta-cell function,” said the researchers.

Practice Pearls:

  • Patients with higher 1-hour post-load hyperglycemia are at risk of developing diabetes.
  • One-hour post-load hyperglycemia had a better diagnostic than impaired fasting glucose.

Fiorentino, Teresa Vanessa, Maria Adelaide Marini, Francesco Andreozzi, Franco Arturi, Elena Succurro, Maria Perticone, Angela Sciacqua, Marta Letizia Hribal, Francesco Perticone, and Giorgio Sesti. “One-hour Post-load Hyperglycemia Is a Stronger Predictor of Type 2 Diabetes than Impaired Fasting Glucose.” The Journal of Clinical Endocrinology & Metabolism (2015).