2hPG Concentrations Research Articles

Body surface area may explain sex differences in findings from the oral glucose tolerance test among subjects with normal glucose tolerance

Background and aimsCurrent guidelines on prediabetes and diabetes (T2D) recommend to regularly perform an oral glucose tolerance test (OGTT) on subjects at risk of T2D. However, it is not known why women tend to have relatively higher 2-h post-load plasma (2hPG) glucose concentrations during OGTT than men. The aim of the present study is to investigate if there are sex differences in fasting plasma glucose (FPG) and 2hPG concentrations in relation to body size in apparently healthy non-diabetic subjects with normal glucose tolerance. We hypothesized that sex differences in glucose tolerance are physiological and related to different body surface area (BSA) in men and women. Methods and resultsA 2-h 75 g OGTT was performed on 2010 subjects aged 45–70 years. Their BSA was calculated using the Mosteller formula. Men and women were separately divided into five BSA levels. Within the normal 2hPG range, women had higher mean 2hPG concentrations during the OGTT than men in all BSA levels estimated by sex-standardized BSA (p for linearity < 0.001). BSA adjusted for age, waist circumference, leisure-time physical activity, and smoking, showed an inverse association with 2hPG concentration in both sexes. Mean FPG concentrations were higher in men than in women. ConclusionsBody size has a negative inverse association with 2hPG concentration in an OGTT even within a physiological plasma glucose range. This may cause underestimation of glucose disorders in individuals with larger BSA and overestimation in individuals with smaller BSA when using an OGTT.

Body surface area and glucose tolerance – The smaller the person, the greater the 2-hour plasma glucose

BackgroundThe oral glucose tolerance test (OGTT) is standardized globally with a uniform glucose load of 75 g to all adults irrespective of body size. An inverse association between body height and 2-hour postload plasma glucose (2hPG) has been demonstrated. Our aim was to evaluate the relationship between body surface area (BSA) and plasma glucose values during an OGTT. MethodsAn OGTT was performed on 2659 individuals at increased cardiovascular risk aged between 45 and 70 years of age, who had not previously been diagnosed with diabetes or cardiovascular disease. Their BSA was calculated according to the Mosteller formula. Study subjects were divided into five BSA levels corresponding to 12.5, 25, 25, 25, and 12.5% of the total distribution. FindingsWhen adjusted for age, sex, waist circumference, alcohol intake, current smoking, and leisure-time physical activity, BSA level showed an inverse linear relationship with the 2hPG in all categories of glucose tolerance (p for linearity < 0.001). Moreover, the smaller the adjusted BSA of the study person, the higher the proportion of newly diagnosed type 2 diabetes based on 2hPG in the OGTT. InterpretationBody size has a considerable impact on the findings from a standardized OGTT. Smaller persons are more likely to be diagnosed as glucose intolerant than relatively larger sized individuals. FundingThis work was supported by the State Provincial Office of Western Finland, the Central Satakunta Health Federation of Municipalities, Satakunta Hospital District, and the Hospital District of Southwest Finland. Research in contextEvidence before this study. We searched PubMed using the MeSH terms “glucose tolerance test”, “body surface area”, “body height”, “body size”, “glucose tolerance”, “insulin resistance”, “blood glucose” and “diabetes mellitus” on March 10, 2019 without language restrictions. We also used Cited Reference Search in Web of Science for relevant articles. The oral glucose tolerance test (OGTT) is standardized globally with a uniform glucose load of 75 g to all adults irrespective of body size. An inverse association between body height and 2-hour postload plasma glucose (2hPG) has been demonstrated. Several studies have shown that 2hPG predicts all-cause mortality better than elevated fasting glucose. However, body height or body surface area are not usually adjusted in epidemiological studies. It is well known that short adult stature is a risk factor for cardiovascular and all-cause mortality.Added value of this study. This is the first study to assess the relationship of body surface area and 2hPG in a typical primary care population at increased cardiovascular risk. Body surface area has a considerable impact on the result of a standardized OGTT. Smaller individuals are more likely to be diagnosed as glucose intolerant than relatively larger sized individuals.Implications of all the available evidence. There is a possibility that the diagnosis of type 2 diabetes made by an OGTT is a false positive result in a relatively small individual, and a false negative result in a relatively larger individual. Association of 2hPG concentrations and mortality may be influenced by body size as confounding factor. Given that the OGTT is a time and effort consuming test both for patients and laboratory personnel, validity of the OGTT for different body sizes should be reconsidered.

1490-P: Using Longitudinal Modeling to Find One-Hour Glucose Alternatives to Two-Hour Glucose for Prediction and Diagnosis of Glucose Tolerance

One-hour glucose (1h-PG) during an oral glucose tolerance test (OGTT) is an emerging biomarker for diagnosis and prediction of prediabetes (preDM) and type 2 diabetes (T2D). Our objectives were to: (1) use a longitudinal mathematical model to predict the pattern of glucose rise in 1h-PG and 2h-PG concentration with time and (2) test our predictions in a longitudinal cohort of 52 Pima Indians (baseline age, 26.5±5.8 years; BMI, 36.6±5.8 kg/m2) who were followed for 7.2±3.5 years. Model simulations suggested that the 1h-PG would pass the threshold of 155 mg/dl before the 2h-PG passed the threshold of 140 mg/dl for most individuals, and that the time difference could be as much as several years, depending on the balance of impairments in insulin resistance and early-phase insulin secretion. Using the longitudinal data set, we estimated the times of crossing the 1h-PG and 2h-PG thresholds by fitting a linear mixed effect model to trajectories of individual participants. Participants had a median of 6 (range 3-11) separate OGTTs, 1.7±0.8 years apart. For most participants (48/52), 1h-PG of 155 mg/dl was observed before 2h-PG reached 140 mg/dl (time difference, 1.9±2.0 years). Using the linear fits we also estimated that the average 1h-PG value would be 217 mg/dl (12.0 mmol/L) when 2h-PG reached 200 mg/dl (11.1 mmol/L). Overall, the times of crossing the 1h-PG threshold of 155 mg/dl and the 2h-PG threshold of 140 mg/dl were correlated, but 1h-PG crossed earlier, thus providing an earlier indication of future hyperglycemia. Additionally, since 1h-PG and 2h-PG rise together during the progression from preDM to T2DM, a 1h-PG of 217 mg/dl could be an alternative marker to the 2h-PG of 200 mg/dl for the diagnosis of T2D. Disclosure J. Ha: None. S.T. Chung: None. A.E. Sumner: None. M. Bergman: None. C. Bogardus: None. A. Sherman: None.

Increased self-care activities and glycemic control rate in relation to health education via Wechat among diabetes patients: A randomized clinical trial.

Background:Health education has been considered as the effectiveness method to increase the self-care skills of diabetes patients. However, limited studies to investigate the association of health education via Wechat platform on increased the basic self-care skills and glycemic control rate in patients with type 2 diabetes.Methods:A total number of 120 type 2 diabetes patients were randomized into intervention (health education by Wechat platform plus usual care) and the control group (usual care). Biochemical parameters including fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG), glycosylated hemoglobin A1c (HbA1c) were measured among the 2 groups at baseline 6-month and 12-month. Diabetes Management Self-Efficacy (SE) Scale was completed at baseline 6-month and 12-month.Results:Significant difference of HbA1c concentration and SE were found between intervention and control groups at 6-month and 12-month (P <.05). The effect of groups and health education duration times was found on reduced HbA1c concentration and increased the total score of SE (P <.05). No significant difference of FPG and 2hPG concentrations were found between intervention and control groups at 6 months and 12 months (P >.05).Conclusion:Health education of diabetic individuals via Wechat platform in conjunction with conventional diabetes treatment could improve glycemic control and positively influence other aspects of diabetes self-care skills.

Baseline Characteristics of the Vitamin D and Type 2 Diabetes (D2d) Study: A Contemporary Prediabetes Cohort That Will Inform Diabetes Prevention Efforts.

To describe baseline characteristics of the Vitamin D and Type 2 Diabetes (D2d) study, the first large U.S. diabetes prevention clinical trial to apply current American Diabetes Association (ADA) criteria for prediabetes. This is a multicenter (n = 22 sites), randomized, double-blind, placebo-controlled, primary prevention clinical trial testing effects of oral daily 4,000 IU cholecalciferol (D3) compared with placebo on incident diabetes in U.S. adults at risk for diabetes. Eligible participants were at risk for diabetes, defined as not meeting criteria for diabetes but meeting at least two 2010 ADA glycemic criteria for prediabetes: fasting plasma glucose (FPG) 100-125 mg/dL, 2-h postload glucose (2hPG) after a 75-g oral glucose load 140-199 mg/dL, and/or a hemoglobin A1c (HbA1c) 5.7-6.4% (39-46 mmol/mol). A total of 2,423 participants (45% of whom were women and 33% nonwhite) were randomized to cholecalciferol or placebo. Mean (SD) age was 59 (9.9) years and BMI 32 (4.5) kg/m2. Thirty-five percent met all three prediabetes criteria, 49% met the FPG/HbA1c criteria only, 9.5% met the 2hPG/FPG criteria only, and 6.3% met the 2hPG/HbA1c criteria only. Black participants had the highest mean HbA1c and lowest FPG concentration compared with white, Asian, and other races (P < 0.01); 2hPG concentration did not differ among racial groups. When compared with previous prediabetes cohorts, the D2d cohort had lower mean 2hPG concentration but similar HbA1c and FPG concentrations. D2d will establish whether vitamin D supplementation lowers risk of diabetes and will inform about the natural history of prediabetes per contemporary ADA criteria.

Baseline Characteristics of the Vitamin D and Type 2 Diabetes (D2d) Study—A Contemporary Prediabetes Cohort

Objective: Describe baseline characteristics of the NIH/ADA-supported D2d study, the first diabetes prevention trial in the U.S. to apply current ADA diagnostic glycemia criteria. Research Design and Methods: Multicenter (22 sites), randomized, double-blind, placebo-controlled, primary prevention trial testing efficacy of oral daily 4000 IU cholecalciferol (D3) compared to placebo on incident diabetes in adults at high risk. Eligible participants met at least 2-of-3 2010 ADA glycemic criteria for prediabetes: fasting plasma glucose (FPG) 100-125 mg/dL, 2-hour glucose post-75g oral glucose load (2hPG) 140-199 mg/dL, and/or hemoglobin A1c (HbA1c) 5.7-6.4%. Results: 2423 participants (45% women, 33% non-white) were randomized. Mean (±SD) age was 59 (±9.9) years, and BMI was 32 (±4.5) kg/m2. Thirty-five percent met 3 prediabetes criteria, 49% met FPG/HbA1c criteria only, 9.5% met 2hPG/FPG criteria only, and 6.3% met 2hPG/HbA1c criteria only. Black participants had higher HbA1c and lower FPG concentration than white, Asian, and other races (P&amp;lt;0.01); 2hPG concentration did not differ by race (Table). The D2d cohort has lower 2hPG but similar HbA1c and FPG concentrations than previous prediabetes cohorts. Conclusions: D2d will establish the efficacy and safety of vitamin D supplementation for diabetes prevention and inform on the natural history of prediabetes per contemporary ADA criteria. Disclosure E. LeBlanc: None. R.E. Pratley: Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eisai Inc., GlaxoSmithKline plc., Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Ligand Pharmaceuticals, Inc., Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk Inc., Pfizer Inc., Sanofi-Aventis, Takeda Development Center Americas, Inc.. B. Dawson-Hughes: None. M.A. Staten: None. P.R. Sheehan: None. M.R. Lewis: None. A.L. Peters: Advisory Panel; Self; Abbott, Bigfoot Biomedical. Research Support; Self; Dexcom, Inc.. Advisory Panel; Self; Eli Lilly and Company, Insulin Algorithms, JDRF, Lexicon Pharmaceuticals, Inc., Livongo Health. Research Support; Self; MannKind Corporation. Other Relationship; Self; Medscape. Advisory Panel; Self; Merck &amp; Co., Inc.. Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Speaker's Bureau; Self; Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc., Omada Health, Inc., Optum Rx, Inc., Sanofi. Research Support; Self; T1D Exchange. Advisory Panel; Self; The Endocrine Society. Research Support; Self; The Leona M. and Harry B. Helmsley Charitable Trust. Advisory Panel; Spouse/Partner; Johnson &amp; Johnson Diabetes Institute, LLC.. S.H. Kim: None. R. Chatterjee: None. V. Aroda: Consultant; Self; Novo Nordisk Inc.. Research Support; Self; Novo Nordisk Inc., AstraZeneca, Calibra Medical, Eisai Inc., Sanofi. Consultant; Self; Sanofi. Research Support; Self; Theracos, Inc.. Employee; Spouse/Partner; Merck &amp; Co., Inc.. Other Relationship; Self; American Diabetes Association. Consultant; Self; ADOCIA. C. Chadha: None. A. Pittas: None.

Gliukozės toleravimo mėginio svarba kasdienėje ambulatorinėje praktikoje

Tikslas. Diabetas yra didėjanti neišspęsta visuomenės sveikatos problema visame pasaulyje. Dėl nebylios diabeto eigos daugeliui asmenų ilgą laiką liga yra nenustatoma. Glikemijos nevalgius veninio kraujo plazmoje tyrimai ar gliukozės toleravimo mėginys yra pagrindinės diabeto atrankos ir antrinės prevencijos priemonės. Šio tyrimo tikslas nustatyti gliukozės apykaitos sutrikimų dažnį, glikemijos skirtumus atsižvelgiant į lytį bei amžinius pokyčius ir diabeto raidos greitį suaugusiems asmenims pagal kasdienės sveikatos priežiūros veiklos duomenis. Metodai. VšĮ Antakalnio poliklinikoje vykdyta 2011 m. sausio mėn. – 2014 m. gruodžio mėn. akredituotoje laboratorijoje atliktų gliukozės toleravimo mėginių, atliktų 5933 suaugusiems pacientams, rezultatų analizė. Anonimizuoti duomenys gauti iš laboratorijos elektroninės duomenų bazės. Diabetas, sutrikusi glikemija nevalgius (SGN) ir gliukozės toleravimo sutrikimas (GTS) nustatyti pagal 2006 m. PSO kriterijus. Rezultatai. Vidutinis pacientų amžius buvo 54,02 ± 15,52 m. Vidutinė glikemija nevalgius buvo 6,00 ± 0,89 mmol/l, glikemija 2 val. po krūvio – 6,9 ± 2,25 mmol/l. Vyrų glikemija nevalgius buvo 0,29 mmol/l didesnė nei moterų, o moterų glikemija 2 val. po krūvio buvo 0,16 mmol/l didesnė nei vyrų (p&amp;lt;0,05). Vidutinė glikemija 2 val. po krūvio su amžiumi didėjo, tačiau glikemija nevalgius nuo 50 m. stabilizavosi. Atlikus GTM nauji diabeto atvejai buvo nustatyti 4,9 proc. pacientų, SGN – 25,6 proc., GTS – 5,0 proc., SGN ir GTS derinys – 8,1 proc. Prediabetinės būklės 1,3 karto dažniau nustatytos vyrams nei moterims (p&amp;lt;0,0001). Pakartojus GTM nustatyta 60 naujų diabeto atvejų. Vidutinis laikotarpis po pirmo GTM, per kurį buvo išaiškintas naujo diabeto atvejis, buvo 16,27 ± 10,51 mėnesio. Išvados. Gliukozės toleravimo mėginys – nepakeičiama gliukozės apykaitos sutrikimų diagnozavimo ir antrinės diabeto prevencijos priemonė. 43,6 proc. ambulatorinės sveikatos priežiūros įstaigos pacientų, atlikusių GTM, nustatyti gliukozės apykaitos sutrikimai. Naujai nustatyto cukrinio diabeto dažnis siekė 4,9 proc. Vyrams prediabetinės būklės nustatytos dažniau, vyraujant SNG bei SGN ir GTS deriniui. Moterims dažniau nustatytas GTS. 6,7 proc. pacientų vidutiniškai per 16,27 ± 10,51 mėnesio diagnozuoti nauji diabeto atvejai, 83,3 proc. buvusio GTM metu stebėti gliukozės apykaitos sutrikimai.

Oral glucose tolerance test-based calculation identifies different glucose intolerance phenotypes within the impaired fasting glucose range.

The conventional oral glucose tolerance test (OGTT) cannot detect future diabetics among isolated impaired fasting glucose (is-IFG) nor normal glucose tolerant (NGT) groups. By analyzing the relationship between fasting (FPG) and 2-h plasma glucose (2hPG), the present study identifies is-IFG subjects liable to worsening glucose homeostasis. Oral glucose tolerance test was carried out in 619 patients suffering from obesity, hypertension or dyslipidemia, whose FPG was in the 100-125mg/dL range. We calculated the percentage increment of 2hPG with respect to FPG (PG%) in these patients using the formula: ([2hPG-FPG]/FPG)×100. Differences in β-cell function within is-IFG patients were assessed by estimated insulin sensitivity index (EISI), first-phase insulin release (1stPH) and 1stPH/1/EISI (1stPHcorrected). Diabetes was diagnosed in 69 patients (11.2%), combined IFG/impaired glucose tolerance (IGT) in 185 patients (29.9%) and is-IFG in 365 patients (58.9%). Is-IFG was subdivided into PG% tertile groups: the percentage of females increased from 25% in the lowest to 45.2% in the highest tertile (χ(2)=18.7, P<0.001). Moving from the lowest to the highest PG% tertile group, insulin and 2hPG concentrations rose, whereas FPG, EISI, and 1stPHcorrected decreased progressively and significantly. Furthemore, PG% correlated inversely with EISI (r=-0.44, P<0.0001) and 1stPHcorrected (r=-0.38, P<0.0001). Oral glucose tolerance test does differentiate the great heterogeneity in metabolic disorders of patients with FPG 100-125mg/dL. Furthermore, PG% can expand the diagnostic power of OGTT in the is-IFG range by distinguishing metabolic phenotypes very likely to herald different clinical risks.

Association of β-cell function and insulin sensitivity with fasting and 2-h plasma glucose in a large Chinese population

Our aim was to provide a quantitative analysis of the changes in the principal determinants of insulin sensitivity and secretion in relation to fasting plasma glucose (FPG) or 2-h plasma glucose (2h PG) in a Chinese population with a wide range of glucose tolerance. A total of 5728 adults spanning the entire range of glucose tolerance were included. Insulin sensitivity was measured by Matsuda insulin sensitivity index (ISI(M)) and homeostasis model assessment of 1/homeostasis model assessment of insulin resistance (HOMA-IR). β-Cell function adjusted by insulin sensitivity was assessed from disposition index (DI) at early-phase DI(30) and total DI(120). The exponential curve was established as the best fit for the relationship between insulin sensitivity or β-cell function and FPG or 2h PG. Relative to the trend classified as increasing 2h PG, hepatic insulin sensitivity and insulin secretion showed a decreasing trend to a substantial degree as FPG increased. A 1 mmol/l increase in FPG and 2h PG concentration was associated with a -22 and -21% decline in ISI(M), -16 and -4% in 1/HOMA-IR, -38 and -35% in DI(30) and -36 and -26% in DI(120). The decay constant of ISI(M) and DI(30) in IFG or ISI(M), 1/HOMA-IR, DI(30) and DI(120) in IGT was lower than that in normal glucose tolerance. Significant interactions between sex and glucose levels determining DI were found. We conclude that impairment of insulin sensitivity and insulin secretion contributes to both FPG or 2h PG hyperglycaemia in a Chinese population, but that the decline in insulin secretion is more pronounced with increasing fasting than 2h PG.

Plasma adiponectin concentration is strongly associated with VLDL-TG catabolism in postmenopausal women

Background and aims To investigate associations between plasma adiponectin concentration and very-low density lipoprotein–triglyceride (VLDL-TG) secretion and catabolism in postmenopausal women. Methods and results This cross-sectional study included 30 postmenopausal women. Plasma adiponectin concentration was measured by ELISA. Insulin sensitivity was assessed by a 2-h euglycemic-hyperinsulinemic clamp. Fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPG) were measured during an oral glucose tolerance test. The calculation of VLDL-TG fractional catabolic rate (FCR) and VLDL-TG total secretion rate (TSR) were based on the monoexponential decrease of TG-[ 2H 5] glycerol values obtained following the administration of a 2H 5-glycerol bolus. Plasma adiponectin concentration was negatively associated with VLDL-TG TSR ( r = −0.50; p = 0.005) and positively associated with VLDL-TG FCR ( r = 0.54; p < 0.002). This latter association remained significant after further adjustments for insulin sensitivity, visceral adipose tissue, HDL-C, FPG and 2hPG concentrations. In a multivariate model including adiponectin, insulin sensitivity and 2hPG, plasma adiponectin level was the strongest correlate of VLDL-TG FCR. Conclusions Elevated plasma adiponectin concentration is associated with a favourable VLDL-TG metabolism.

Fasting Plasma Glucose in the Screening for Type 2 Diabetes in Morbidly Obese Subjects

Higher mortality rates among morbidly obese (BMI of > or =40 or > or =35 kg/m2 with weight-related comorbidities) subjects are mainly explained by comorbidities such as type 2 diabetes. As bariatric surgery ameliorates diabetes, obese diabetic subjects will receive great benefits from bariatric surgery. Screening for diabetes prior to surgical referral is therefore crucial. We studied 1,253 consecutively recruited (2005-2008) morbidly obese subjects (67% women). Among subjects without known diabetes, 70% (670/961) performed an oral glucose tolerance test (OGTT). Screen-detected diabetes was defined as fasting plasma glucose (fPG) > or =7.0 mmol/l and/or 2-h glucose concentration (2hPG) > or = 11.1 mmol/l. Within the study population, 31% had diabetes, of which 8% were screen-detected. Eighty percent of those with screen-detected diabetes were diagnosed by fPG. In subjects with nondiabetic fPG concentrations, elevating the fPG cutoff value from 5.2 mmol/l to the World Health Organization's (WHO's) recommended value of 6.1 mmol/l reduced the percentage of the population needing an OGTT considerably (78-23%), but only slightly reduced the sensitivity of fPG in detecting a diabetic 2hPG concentration (100-77%). Only 7% of the patients with fPG between 6.1 and 6.9 mmol/l had a diabetic 2hPG concentration. Following the WHO's recommendations, we found that 95% of all subjects with unknown diabetes were identified. Fasting glucose identified four out of five morbidly obese subjects with unknown diabetes. A supplemental OGTT in selected persons identified the majority of the remaining diabetic cases.

Dietary Patterns Predict Changes in Two-Hour Post-Oral Glucose Tolerance Test Plasma Glucose Concentrations in Middle-Aged Adults

We examined whether the adherence to major dietary patterns at baseline of 5824 nondiabetic Danes (30–60 y) enrolled in the nonpharmacological Inter99 intervention predicted changes in fasting plasma glucose (FPG) and postchallenge 2-h plasma glucose (2h-PG) concentrations during a 5 y period and whether a potential association was dependent on baseline glucose tolerance status. Through principal component analysis, a score for a traditional dietary pattern (characterized by higher intakes of high-fat sandwich spreads, red meat, potatoes, butter and lard, low-fat fish, sandwich meat, and sauces) and a score for a modern dietary pattern (characterized by higher intakes of vegetables, fruit, vegetable oil/vinegar dressing, poultry, pasta, rice, and cereals) were estimated for each person at baseline. Random effect models adjusting for relevant confounders were used to estimate changes in repetitive measures of FPG and 2h-PG. A higher modern score (of 1 SD) predicted an annual decrease in 2h-PG of 0.015 mmol/L (P < 0.01) regardless of glucose tolerance status. For individuals with isolated impaired glucose tolerance, a higher traditional score (of 1 SD) predicted an annual increase in 2h-PG of 0.083 mmol/L (P < 0.0001). In conclusion, glucose tolerance status did not, in general, affect the predictive effect of the dietary patterns. The study suggests that the risk of worsening 2h-PG concentrations may be smaller for individuals with a high modern dietary pattern score characterized by high intakes of vegetables, fruit, vegetable oil/vinegar dressing, poultry, pasta, rice, and cereals.

High normal 2-hour plasma glucose is associated with insulin sensitivity and secretion that may predispose to type 2 diabetes

The aim of this study was to evaluate differences in insulin sensitivity, insulin secretion and risk factors for cardiovascular disease between subjects with a 2-h plasma glucose (2hPG) level within the normal range (NPG) and subjects with IGT, following a 75-g OGTT. We also aimed to determine the respective contributions made by 2hPG and fasting plasma glucose to the metabolic risk profile. We compared cardiovascular risk factors and insulin sensitivity and insulin secretion by using several indices calculated using measurements obtained during an OGTT. Subjects (n=643, age 18-71 years) were participants in the Quebec Family Study and were categorised according to 2hPG as having low NPG (2hPG <5.6 mmol/l, the group median for normal values), high NPG (2hPG 5.6-7.7 mmol/l) or IGT (2hPG 7.8-11.0 mmol/l). Subjects with type 2 diabetes were excluded from all analyses. Beta cell function and insulin sensitivity progressively decreased with increasing 2hPG. Compared with subjects with low NPG, subjects with high NPG were more insulin-resistant (p<0.05) and had reduced insulin secretion (adjusted for insulin resistance) (p<0.001). They also had higher plasma triglyceride concentrations (p<0.01) and cholesterol:HDL cholesterol ratios (p<0.05). These differences remained even after adjustment for age, sex, BMI and waist circumference. Multivariate analyses showed that 2hPG was closely associated with risk factors for diabetes and with cardiovascular variables, including triglycerides (p<0.0001) and apolipoprotein B (p<0.01). These results show that deteriorations in glucose-insulin metabolism, which may predispose individuals to type 2 diabetes and cardiovascular disease, are already present in subjects with 2hPG concentrations within the high normal range. Independently of obesity, 2hPG was found to explain, in part, the variance observed in cardiovascular and diabetes risk factors. In addition, elevated 2hPG was associated with metabolic alterations that appear to be the most detrimental to metabolic health. Thus, 2hPG values within the high normal range may be an important marker for the identification of people at risk of complications related to type 2 diabetes.