Glucose patterns during an oral glucose tolerance test and associations with future diabetes, cardiovascular disease and all-cause mortality rate.

Abstract

In addition to blood glucose concentrations measured in the fasting state and 2h after an OGTT, intermediate measures during an OGTT may provide additional information regarding a person's risk of future diabetes and cardiovascular disease (CVD). First, we aimed to characterise heterogeneity of glycaemic patterns based on three time points during an OGTT. Second, we compared the incidences of diabetes and CVD and all-cause mortality rates among those with different patterns. Our cohort study included 5861 participants without diabetes at baseline from the Danish Inter99 study. At baseline, all participants underwent an OGTT with measurements of plasma glucose levels at 0, 30 and 120min. Latent class mixed-effects models were fitted to identify distinct patterns of glycaemic response during the OGTT. Information regarding incident diabetes, CVD and all-cause mortality rates during a median follow-up time of 11, 12 and 13years, respectively, was extracted from national registers. Cox proportional hazard models with adjustment for several cardiometabolic risk factors were used to compare the risk of diabetes, CVD and all-cause mortality among individuals in the different latent classes. Four distinct glucose patterns during the OGTT were identified. One pattern was characterised by high 30min but low 2h glucose values. Participants with this pattern had an increased risk of developing diabetes compared with participants with lower 30min and 2h glucose levels (HR 4.1 [95% CI 2.2, 7.6]) and participants with higher 2h but lower 30min glucose levels (HR 1.5 [95% CI 1.0, 2.2]). Furthermore, the all-cause mortality rate differed between the groups with significantly higher rates in the two groups with elevated 30min glucose. Only small non-significant differences in risk of future CVD were observed across latent classes after confounder adjustment. Elevated 30min glucose is associated with increased risk of diabetes and all-cause mortality rate independent of fasting and 2h glucose levels. Therefore, subgroups at high risk may not be revealed when considering only fasting and 2h glucose levels during an OGTT.