Normal Glucose Tolerance Test Research Articles

Small Donors, Big Impact: Optimizing Organ Utilization in Simultaneous Pancreas and Kidney Transplantation From Extra Small Pediatric Donors.

Simultaneous pancreas-kidney transplantation (SPK) is the preferred treatment for individuals with type-1 diabetes and end-stage renal disease. However, a limited supply of "Ideal Pancreas Donors" contributed to a growing disparity between available organs and recipients. Even though SPK outcomes from pediatric donors match those from adult donors, unclear guidelines on minimum age and weight criteria for extra small pediatric pancreas donors lead to hesitancy among several transplant centers to utilize these grafts due to concerns about inadequate islet mass, technical challenges, and increased risk of allograft thrombosis. This report details the successful outcomes of SPK transplantations performed at the study center between December 2021 and January 2024, using four extra small pediatric brain-dead donors (ESPDs). Each donor was aged ≤5 years and weighed <20kg. All SPK recipients achieved immediate posttransplant euglycemia without requiring insulin. None of the recipients experienced graft pancreatitis, graft thrombosis, allograft rejection, or required re-exploration. During a 5-27-month follow-up period, all ESPD recipients maintained optimal graft function, as evidenced by normal glucose tolerance tests and HbA1c (4.9%-5.2%), with 100% graft and patient survival. This report examines the usage of ESPDs in SPK transplantation, highlighting their potential to expand the donor pool and reduce wait times in areas with scarce deceased organ donations, thereby increasing the number of available organs for transplantation with acceptable outcomes. Revising donor selection guidelines to reflect the diverse risk-benefit profiles of waitlisted individuals is crucial to addressing geographical disparities and reducing organ discard rates.

Maternal and Neonatal Outcomes with One Abnormal Value on 100g Three Hour Glucose Tolerance Test in Pregnancy

Purpose: The primary objective of this study was to compare pregnancy outcomes for patients with no elevated glucose values, one elevated glucose value, and 2 or more elevated glucose values on the 3-hour glucose tolerance test (GTT). Methods: This was a retrospective chart review of obstetric patients seen by residents and attending physicians at a single institution from 2015 to 2020 who were required to complete a 3-hour glucose tolerance test (GTT). Data extracted from the maternal chart included demographic information, BMI, route of delivery, presence of preeclampsia, chorioamnionitis, shoulder dystocia and preterm labor. Data extracted from the neonatal chart included blood glucose level after birth, birth weight, Apgar scores, and if NICU admission was required. Continuous data were analyzed using one-way ANOVA to compare the 3 groups, followed by post-hoc Tukey HSD to compare the 1 abnormal value group to the control group. Dichotomous data were analyzed using Chi square tests. Logistic regression was performed using shoulder dystocia as the outcome. Results: Patients with two or more elevated GTT values had higher age and BMI and were more likely to be prescribed diabetic medications compared to those with normal or one elevated value. They were also more likely to deliver at an earlier gestational age. Patients with one elevated GTT value experienced a statistically significant higher chance of shoulder dystocia compared to patients with all normal GTT results (OR 2.34; 95% CI 1.05, 5.20). Patients with two or more elevated values were more likely to have preeclampsia and a neonate requiring NICU admission. There were no differences in cesarean delivery rate, hemorrhage or chorioamnionitis between the groups. Conclusions: Patients with one elevated GTT value are a special subset of patients who do not meet criteria for gestational diabetes, yet do not have normal glucose testing results. We hypothesize that this group is at higher risk of shoulder dystocia because these patients may have hyperglycemia but often do not receive the same type of monitoring, dietary education, medication initiation and induction timing as patients who meet criteria for gestational diabetes.

Prevalence of Retinopathy in Prediabetic Populations: A Systematic Review and Meta-Analysis.

Among the leading causes of vision impairment and blindness globally, diabetic retinopathy (DR) is one of the most important causes. There is increasing evidence of DR prevalence in the prediabetic population. This systematic review presents collective data on retinopathy in the prediabetic population. This review article aimed to estimate the reported prevalence of retinopathy in prediabetes, impaired glucose tolerance test (GTT) without diabetes mellitus, and the risk factors involved and to summarize it. Literature searches were done using the Web of Science, CINAHL, Google Scholar, Cochrane, EMBASE, and PubMed databases from inception to April 2023. Our search included the words prediabetes, DR, and risk factors. All searches were looked at for methodological quality and evidence. Thirty-one studies were included after the screening. Population-based data were used in 23 studies (82.1%). The prediabetic population screened was 10,539. The prevalence of retinopathy ranged between 0.3% and 20.9%, showing a median of 8.1% with an interquartile range (IQR) of 4.2-11%, showing great variance in estimates due to the use of different screening methods, methods used for retinopathy grading, and study populations. Several studies compared the population with normal GTT with impaired glucose tolerance (IGT) and inferred that there was a lower prevalence of retinopathy in the normal GTT population (3.0%, IQR 0.3-7.4%) than prediabetes (6.7%, IQR 1.9-10.1%). According to this data, a greater retinopathy prevalence was found in prediabetic populations.

Relations Between Body Fat Mass and Insulin Resistance in Non-Obese Patients with Idiopathic Hypogonadotropic Hypogonadism and Normal Glucose Tolerance.

The purpose of this study was to investigate the relationship between body fat mass and insulin resistance in non-obese patients with idiopathic hypogonadotropic hypogonadism (IHH) and normal glucose tolerance. A total of 42 patients with IHH and normal glucose tolerance, and BMI lower than 28 kg/m2 were recruited. Patients were required to have a normal glucose tolerance test for inclusion in the study. Ten Healthy subjects were recruited as control group. Laboratory studies included fasting insulin, testosterone, and lipids. Waist circumference (WC), weight, and body fat mass were measured, and waist-to-hip ratio (WHR), body mass index (BMI), HOMA-IR, and logHOMA-B were calculated. Data were compared between groups, and linear regression was used to determine relations. Blood pressure, fasting glucose, BMI, WHR, and lipids were similar between the groups. Fasting insulin levels (15.61±7.66 mIU/l vs. 7.60±3.84 mIU/l), logHOMA-B (2.39±0.29 vs. 2.03±0.21), HOMA-IR (3.38±1.71 vs. 1.64±0.91), and body fat mass (30.49±9.46% vs. 21.11±4.31%) were significantly greater in the IHH group compared with those in control group (all p<0.05). Multivariable linear regression showed that in IHH patients body fat mass was an independent predictor of fasting insulin level (β=0.71, p<0.01), logHOMA-B (β=0.02, p<0.05), and HOMA-IR (β=0.14, p<0.05). Body fat mass is an independent predictor of insulin resistance in non-obese IHH patients with normal glucose tolerance.

The ability of a low value on an early GCT to identify women not needing repeat testing in the second trimester

Objective To evaluate the predictive value of a low early glucose challenge test (GCT) in ruling out a subsequent diagnosis of gestational diabetes in the second trimester. Methods This was a retrospective cohort study of women at a single clinic who had a normal early GCT between 2016 and 2020. Patients who did not have repeat screening in the late second trimester were excluded. Demographic data were extracted from the record. The primary outcome was a normal GCT or glucose tolerance test in the late second trimester. Logistic regression and receiver operator curves (ROC) were performed to assess the ability of the early GCT value to predict subsequent normal glucose screening. Results Of the 532 pregnant persons with normal early GCT, 62 (11.7%) were subsequently diagnosed with gestational diabetes in the second trimester. None of the patients (N = 56), who had a GCT value less than 80 mg/dL were diagnosed with gestational diabetes in the second trimester. The prediction of subsequent normal screening using the early GCT on a ROC plot produced an area under the curve (AUC) of 0.67, 95% CI (0.60–0.74). Adding age, prior history of gestational diabetes and family history of diabetes mellitus to the prediction, only improved the AUC to 0.75, 95% CI (0.66, 0.82). Conclusion Early GCT value was a fair predictor for normal second trimester glucose testing for gestational diabetes. However, high-risk patients with an early GCT value of less than 80 mg/dL may be able to forego repeat second trimester screening.

1383-P: Relationship between Body Fat Mass and Insulin Resistance in Nonobese Patients with Idiopathic Hypogonadotropic Hypogonadism and Normal Glucose Tolerance

Objective: The purpose of this study was to investigate the relations between body fat mass and insulin resistance in non-obese patients with idiopathic hypogonadotropic hypogonadism (IHH) and normal glucose tolerance. Methods: A total of 42 patients with IHH and BMI lower than 28 kg/m2 from January 2013 to October 2017 were recruited. Patients were required to have a normal glucose tolerance test for inclusion in the study. Ten Healthy subjects having a routine physical examination and a normal glucose tolerance test were also recruited as control group. Laboratory studies included fasting insulin, testosterone, and lipids. Waist circumference (WC) , weight, and body fat mass were measured, and waist-to-hip ratio (WHR) , body mass index (BMI) , HOMA-IR, and LogHOMA-B were calculated. Data were compared between groups, and linear regression was used to determine relations. Results: Blood pressure, fasting glucose, BMI, WHR, and lipids were similar between the groups. Fasting insulin levels (15.61 ± 7.66 mIU/L vs. 7.60 ± 3.84 mIU/L) , logHOMA-B (2.39 ± 0.29 vs. 2.03 ± 0.21) , HOMA-IR (3.38 ± 1.71 vs. 1.64 ± 0.91) , and body fat mass (30.49 ± 9.46% vs. 21.± 4.31%) were significantly greater in the IHH group compared with those in control group (all, P &amp;lt; 0.05) . Multivariable linear regression showed that in IHH patients body fat mass was an independent predictor of fasting insulin level (β = 0.71, 95% confidence interval [CI]: 0.54, 0.88, P &amp;lt; 0.01) , LogHOMA-B (β = 0.02, 95% CI: 0.001, 0.032, P &amp;lt; 0.05) , and HOMA-IR (β = 0.14, 95% CI: 0.09, 0.18, P &amp;lt; 0.05) . Conclusion: Body fat mass is an independent predictor of insulin resistance in IHH patients with normal glucose tolerance. Disclosure H.Xu: None. X.Chen: None. X.Yang: None. W.Xu: None. Funding This study was supported by Natural Science Foundation of Guangdong Province [2018A030313915]; Medical Scientific Research Foundation of Guangdong Province of China [A2018286].

198-OR: Altered Prandial Glucose Metabolism in Nondiabetic Subjects with Spinal Cord Injury Is Associated with Impaired Insulin Secretion and Clearance

Patients with spinal cord injury (SCI) develop type 2 diabetes earlier and at 2-3 times higher frequency compared to the matched able-bodied persons (AB) . The difference in glucose abnormalities among SCI and AB cohorts remains after adjusting for known risk factors for DM, such as decreased physical activity, or lower body lean mass, or larger visceral fat mass. The mechanism for this dramatic effect of SCI on glucose metabolism is unknown but is consistent with endocrine-neurological alterations after injury. We hypothesized that SCI is associated with abnormalities in prandial glucose metabolism and β-cell function. To test this hypothesis glucose, insulin, and C-peptide levels were measured during 3-hr mixed meal tolerance test in 4 non-diabetic SCI (3M/1F, ages 33-61 years) and 6 age-matched AB with normal glucose tolerance test (2M/4F, ages 37-57 years) . SCI subjects had lower BMI (p=0.05) and A1C (p&amp;lt;0.05) than AB (SCI vs. AB; BMI range: 19-29 vs. 25-39 kg/m2; A1C range: 5.0-5.3 vs. 5.3-5.9%) . Fasting values of glucose, insulin, C-peptide, insulin sensitivity (HOMA-IR) , and insulin clearance (CP/insulin) were similar between SCI and AB. Prandial glucose (AUCGlucose3h) and insulin (AUCInsulin3h) responses, however, were greater in SCI than AB (p&amp;lt;0.01) . Despite larger prandial insulinemia β-cell output (AUCC-peptide3h) did not differ among 2 groups. This was consistent with a diminished insulin clearance (Total AUCC-peptide3h / Total AUCInsulin3h) in SCI compared to AB by 3-fold (p&amp;lt;0.05) . Oral glucose insulin sensitivity (OGIS) was similar between 2 groups while β-cell glucose sensitivity and disposition index were smaller in SCI than AB by 2-fold (p=0.08) . These findings indicate that among subjects with normal glucose tolerance, those with SCI have larger prandial glycemic concentration despite lower BMI and A1C. This glycemic effect of SCI is associated with impaired β-cell function as well as insulin clearance. Disclosure M.Trbovich: None. R.Dimas: None. M.Salehi: None.

Analysis on Family History of Diabetes, Weight Gain during Pregnancy and Pre-pregnancy Body Mass Index on 82 Pregnant Women with Gestational Diabetes Mellitus

Objective: To investigate the effects of family history of diabetes mellitus, Gestational Weight Gain (GWG) and Body Mass Index (BMI) before pregnancy on Gestational Diabetes Mellitus (GDM). Method: 82 pregnant women with GDM who were hospitalized and delivered in the obstetrics department of our hospital from September 2017 to September 2019 were selected as the observation group, and 60 pregnant women with normal glucose tolerance test in the same period were selected as the control group; The relationship between family history of diabetes, weight gain during pregnancy and pre-pregnancy Body Mass Index and GDM were analyzed. Results: The age, pre-pregnancy weight and weight gain during pregnancy were significantly higher in the observation group than in the control group (P &lt; 0.05), and the family history of diabetes and pre-pregnancy Body Mass Index were higher in the observation group than in the control group (P &lt; 0.05), and the differences were statistically significant. Conclusion: It is suggested that family history of diabetes is related to gestational diabetes mellitus. Excessive GWG growth during pregnancy and high Body Mass Index before pregnancy may increase the risk of gestational diabetes mellitus in pregnant women.

Evolution of Combined Impaired Fasting Glucose and Impaired Glucose Tolerance in β-Thalassemia Major: Results in 58 Patients with a Mean 7.7- year Follow-Up.

Background:Advances in β- thalassemia major (β-TM) care have transformed a disease which had previously led to an early childhood death into a chronic condition. With increased lifespan, comorbidities associated with the disease have become more common, among them glucose dysregulation (GD) which develops insidiously, aggravating prognosis and patients’ quality of life.Objectives:The objectives of this study were to retrospectively review the extent to which β-TM patients, having combined impaired fasting glucose (IFG) and impaired glucose tolerance test (IGT) on oral glucose tolerance test (OGTT), progressed to diabetes and to analyze the potential determinants inducing this progression, or regression to normal glucose tolerance test (NGT).Research design and method:Data of 58 β-TM patients, followed for a mean duration of 7.7 years (range: 1-20 years) with annual or biennial OGTT, were retrieved. Insulin release and insulin sensitivity (IS) were also analyzed.Results:During the follow-up, FPG and 2-h PG levels after OGTT reverted to NGT in 13 patients (22.4%), deteriorated in 13 patients (22.4%) who developed diabetes mellitus, and did not change in the remaining 32 patients (55.2%). A significant correlation was observed between FPG and ALT level (r: 0.3158; P:0.01) and an inverse correlation was found between chronological age and serum ferritin (SF) level (r: -0.321; P:0.014). Finally, SF and ALT, both at the baseline and at the time of last observation, were independent predictors of evolution to diabetes mellitus.Conclusion:The combination IFG/IGT in β-TM patients with severe iron overload constitutes a high-risk state for developing diabetes. (www.actabiomedica.it)

Low normal glucose tolerance test as a predictor of small for gestational age infants

The glucose tolerance test (GTT) is the gold standard for diagnosing gestational diabetes mellitus (GDM), treatment of which can reduce maternal and fetal complications. While emphasis is placed on monitoring and treatment following an elevated one hour GTT ( >=135 mg/dL), low results (< = 95 mg/dL) could be associated with placental insufficiency. We evaluated the association between small for gestational (SGA) infants and low normal one-hour GTT screening tests.

A case-control study to predict the risk of gestational diabetes mellitus by initial fasting blood sugar or past gestational history.

BackgroundGestational diabetes mellitus (GDM) deserves proper prevention, diagnosis, and management due to healthcare implications from both maternal and fetal concerns.ObjectiveTo evaluate the rate and investigate the risk factors for developing GDM.Materials and MethodsIn this case-control, universal screening for GDM between 24 and 28 wk of gestation was performed in 613 pregnant women attending a prenatal clinic in Tehran who were followed-up until delivery between March 2017 to March 2018. Of the 613 women, 143 had GDM and 470 had normal glucose tolerance test as the primary diagnosis. Some GDM risk factors were compared in two groups.Results Impaired glucose tolerance test was detected in 143 (23.3%) patients. Prevalence of GDM was higher in the first-trimester fasting blood sugar (FBS) 90 qmg/dl group (p 0.001). Comparison of the GDM and the normal glucose tolerance test groups demonstrated significant differences in maternal age, first-trimester FBS, third-trimester vitamin D level, maternal platelet count, maternal body mass index (BMI) (before 12 wk of gestation), weight gain during pregnancy, and the history of gestational complications in previous pregnancy (p 0.01). In logistic regression, GDM was independently associated with older maternal age, higher first-trimester FBS, the history of gestational complications in previous pregnancy, lower third-trimester vitamin D level, and higher maternal platelet count (p 0.01).ConclusionBoth patients with higher initial FBS and the history of gestational complications in previous pregnancy should be considered high risk for GDM and screened earlier.

Long-Term Follow-up of β-Transfusion-Dependent Thalassemia (TDT) Normoglycemic Patients with Reduced Insulin Secretion to Oral Glucose Tolerance Test (OGTT): A Pilot Study.

ObjectiveTo study the endocrine pancreas’ function in transfusion-dependent β-thalassemia (β-TDT) patients with a normal glucose tolerance test (NGT) and hypoinsulinemia. In addition, the prospective long–term follow-up using an annual oral glucose tolerance test (OGTT) to detect any abnormality of glucose metabolism.Patients and methodsSeven β-TDT patients (mean age 22.4 ± 4.2 years) with NGT and inadequate insulin response (hypoinsulinemia) to OGTT were referred for a second opinion to an Italian Centre.ResultsThe first-phase insulin response (FPIR), expressed as the sum of 1 and 3 minutes insulin, to intravenous glucose tolerance test (IVGTT), was between the 1st and 3rd percentile in two patients and between the 3rd and 10th percentile in five. The results were not associated with β-cell autoimmunity. After 43 ± 26 months (range 11 – 80 months) of follow-up, two patients developed impaired glucose tolerance (IGT), three both IGT and impaired fasting glucose (IFG) and two overt diabetes mellitus (DM). Interestingly, the patients who developed DM had, at baseline, the lowest value of the insulinogenic index (IGI: 0.08 and 0.25), defined as the ratio of the increment of plasma insulin to plasma glucose during the first 30 minutes after OGTT. Moreover, a significant correlation was found between the IGI at baseline and at follow-up in the patients who developed IGT with or without IFG (R= 0.927; P: 0.023). A significant reduction of Matsuda insulin sensitivity index (ISIM) and Insulin Secretion-Sensitivity Index-2 (ISSI-2) was documented in the study cohort at the diagnosis of IFG, IGT, and DM. There was a significant inverse correlation between ISSI-2 and area under the curve plasma glucose (AUC-PG).ConclusionsThese data demonstrated, for the first time, progressive deterioration in glucose homeostasis in β-TDT subjects with NGT and hypoinsulinemia and that the ISSI-2 index may be a valuable parameter to identify patients at high risk for developing glucose dysregulation.

Beta cell function in participants with single or multiple islet autoantibodies at baseline in the TEDDY Family Prevention Study: TEFA.

AimThe aim of the present study was to assess beta cell function based on an oral glucose tolerance test (OGTT) in participants with single islet autoantibody or an intravenous glucose tolerance test (IvGTT) in participants with multiple islet autoantibodies.Materials and methodsHealthy participants in Sweden and Finland, between 2 and 49.99 years of age previously identified as positive for a single (n = 30) autoantibody to either insulin, glutamic acid decarboxylase, islet antigen‐2, zinc transporter 8 or islet cell antibodies or multiple autoantibodies (n = 46), were included. Participants positive for a single autoantibody underwent a 6‐point OGTT while participants positive for multiple autoantibodies underwent an IvGTT. Glucose, insulin and C‐peptide were measured from OGTT and IvGTT samples.ResultsAll participants positive for a single autoantibody had a normal glucose tolerance test with 120 minutes glucose below 7.70 mmol/L and HbA1c values within the normal range (<42 mmol/mol). Insulin responses to the glucose challenge on OGTT ranged between 13.0 and 143 mIU/L after 120 minutes with C‐peptide values between 0.74 and 4.60 nmol/L. In Swedish participants, the first‐phase insulin response (FPIR) on IvGTT was lower in those positive for three or more autoantibodies (n = 13; median 83.0 mIU/L; range 20.0‐343) compared to those with two autoantibodies (n = 15; median 146 mIU/L; range 19.0‐545; P = .0330).ConclusionParticipants positive for a single autoantibody appeared to have a normal beta cell function. Participants positive for three or more autoantibodies had a lower FPIR as compared to participants with two autoantibodies, supporting the view that their beta cell function had deteriorated.

Brown Adipose Tissue: A Potential Site for Islet Transplantation.

Islet transplantation is a promising treatment in patients with complicated diabetes. The ideal transplant site that can extend islet graft survival and reduce the required number of engrafted islets remains to be established. Donor islets were isolated from red fluorescent protein (RFP) mice and transplanted into interscapular brown adipose tissue (BAT) or unilateral inguinal white adipose tissue of age-matched diabetic RFP mice. Blood glucose and body weight of the mice were monitored, and vitality and function of ectopic RFP islets were detected by fluorescence imaging, histological examination, and intraperitoneal glucose tolerance test (GTT). BAT enabled the marginal number of grafted islets (80 islets) to restore blood glucose, insulin level, and GTT to normal values in all diabetic recipient mice in the short term after graft, and maintained these values for 1 year at the end of the experiment. Importantly, in the short term after transplantation, abundant extra- and intraislet neovasculatures were observed in BAT, but not in white adipose tissue, which allowed the ectopic islets to retain typical architecture and morphology and contributed to the normal GTT. Moreover, the islet-engrafted BAT displayed normal structure and morphology without significant immunocyte infiltration, and the recipient mice also showed normal lipid levels in the blood. BAT remarkably enhances the viability and biological function of the transplanted ectopic islets. Moreover, the anatomical location of BAT lends itself to biopsy, removal, and islet retransplantation, which strongly suggests the BAT as a potential desirable site for islet transplantation in basic and clinical research.

Severity of the metabolic syndrome as a predictor of prediabetes and type 2 diabetes in first degree relatives of type 2 diabetic patients: A 15-year prospective cohort study.

BACKGROUNDType 2 diabetes mellitus (T2DM) has high morbidity and mortality worldwide, therefore there is of paramount importance to identify the risk factors in the populations at risk early in the course of illness. A strong correlation between severity of metabolic syndrome (MetS) and HbA1c, fasting insulin and insulin resistance has been reported. Accordingly, the MetS severity score (or MestS Z-score) can potentially be used to predict the risk of T2DM progression over time.AIMTo evaluate the association the of MestS Z-score in first degree relatives (FDRs) of T2DM with the risk of prediabetes and type 2 diabetes in future.METHODSA prospective open cohort study was conducted between 2003-2018. At baseline, the sample comprised of 1766 FDRs of patients with T2DM who had a normal glucose tolerance test. Relative risk (RR) and 95% confidence interval were calculated based on logistic regression. The receiver-operator characteristic analysis and area under the curve based on MetS Z-score were used to evaluate the risk of prediabetes and diabetes among the FDR population.RESULTSBaseline MetS Z-scores were associated with the its latest values (P < 0.0001). Compared with individuals who were T2DM free at the end of follow up, those who developed T2DM had higher MetS Z-score at baseline (P < 0.001). In multivariable logistic regression analyses for every unit elevation in MetS Z-score at the baseline, the RR for developing future T2DM and prediabetes was (RR = 1.94, RR = 3.84), (RR = 1.5, RR = 2.17) in total population and female group, respectively (P < 0.05). The associations remained significant after adjusting the potential confounding variables. A cut off value of 0.97 and 0.94 was defined in the receiver-operator characteristic curve based on the MetS Z-score for differentiating female patients with diabetes and prediabetes from the normal population, respectively.CONCLUSIONThe MetS Z-score was associated with an increased risk of future T2DM. Appropriate interventions at earlier stages for preventing and attenuating MetS effects may be considered as an effective strategy for FDR as at-risk population.

A Cross-Sectional Study of the Association between the 1-Hour Oral Glucose Tolerance Test and the Metabolic Syndrome in a High-Risk Sample with Impaired Fasting Glucose

Objective: The aim of this study was to evaluate the association between the 1-hour oral glucose tolerance test (OGTT) (≥155 mg/dL) and metabolic syndrome (MS) in a sample with previous impaired fasting glucose (IFG). Methods: Three hundred and twenty four Peruvian subjects with a history of IFG ≥100 mg/dL were selected for a cross-sectional study. They underwent a 75 g OGTT and were assigned to different groups according to the result. We evaluated the association between 1-hour OGTT and MS. Results: The mean age was 56.5 ± 12.6 years and 191 (61.5%) were female. During the OGTT, we found 28 (8.6%) subjects with diabetes, 74 (22.8%) with IGT, and 222 (68.5%) with a normal glucose tolerance test with a 2-hour glucose <140 mg/dL (NGT). In the NGT group, 124 (38.3%) had 1-hour glucose levels <155 mg/dL, while 98 (30.2%) had 1-hour glucose levels ≥155 mg/dL. Evaluating the association between the 1-hour value in the OGTT and MS, we found that subjects with a 1-hour glucose ≥155 mg/dL were more than twice as likely to have MS as those with a 1-hour glucose <155 mg/dL (odds ratio = 2.64, 95% confidence interval: 1.52 to 4.57). In addition, body mass index, fasting glycemia, triglycerides, and waist circumferences were significantly higher in subjects with 1-hour glucose levels ≥155 mg/dL compared to those with 1-hour glucose levels <155 mg/dL (P<.05). Conclusion: Among subjects with IFG, performing an OGTT was helpful to identify subjects with 1-hour glucose levels ≥155 mg/dL and NGT who were significantly more likely to have MS and a worse cardiometabolic risk profile. Abbreviations: AST = aspartate aminotransferase; BMI = body mass index; CI = confidence interval; IFG = impaired fasting glucose; IGT = impaired glucose tolerance; LDL = low-density lipoprotein; MS = metabolic syndrome; NGT = normal glucose tolerance; OGTT = oral glucose tolerance test; OR = odds ratio; T2DM = type 2 diabetes; TG = triglycerides.

490: Consider performing 3-hour GTT when rescreening for GDM in pregnancy

To determine whether women with an elevated early one-hour glucose challenge test (glucola) and a normal 3-hour glucose tolerance test (GTT) should undergo reassessment for gestational diabetes mellitus (GDM) with the glucola screen or the GTT in late second or third trimester. It is recommended that women at higher risk of diabetes be screened early in pregnancy with the glucola test. Those who screen positive (>=130 mg/dL) undergo confirmatory testing with the GTT. Women with normal GTT results are rescreened for GDM later in pregnancy. This is an Institutional Review Board-approved retrospective study of all women who underwent glucola screening at less than 20 weeks (early screening). Of those women who failed the early glucola and passed the early GTT, we assessed whether they had subsequent screening with a glucola or just a repeat GTT in the late second or third trimester (routine screening). The primary outcome was the percentage of women who subsequently failed the glucola test later pregnancy. There were 3040 women who had an early glucola (Figure). Of those, 635 (21%) had a screening value greater than or equal to 130 mg/dL. Of those who failed the early glucola, 490 underwent subsequent GTT, 489 of whom did not meet Carpenter Coustan criteria for diagnosis of GDM. These women were rescreened for GDM in late second or third trimester: 203 underwent glucola and 286 underwent GTT. Married women were more likely to have a late second trimester/third trimester glucola screen rather than GTT. One-hundred and forty-one (69%) of the women who failed the initial glucola (and passed the GTT) again failed the glucola administered later in gestation. Women with an elevated early glucola and normal GTT should be counseled that they have 69% chance of failing the routine glucola screen at 24-28 weeks. They should be given the option of directly performing the glucose tolerance test (at time of routine assessment) in lieu of glucola screen. Otherwise, they may be subject to a delay in diagnosis and two additional oral glucose loads.

839: 3h-GTT single pathological value during pregnancy is a risk factor for developing future diabetes mellitus

To evaluate the association of 3 hours 100g Glucose Tolerance Test (GTT) results and the development of future diabetes mellitus. Retrospective cohort study of women between 18 to 45 years who underwent a 3 hours GTT during pregnancy and delivered in a tertiary affiliated medical center between the years 2007-2014. According to GTT values, patients were divided into three groups: (A) Normal GTT; (B) Impaired Gestational Glucose Tolerance (single pathological GTT value, IGT) and (C) Gestational Diabetes Mellitus (two or more pathological values, GDM). Future diagnosis of diabetes mellitus was recorded among the groups. 1) Overall, 5011 parturients who underwent a 3 hour GTT were detected and followed for a median period of 64 months (interquartile range of 32). 2) Compared with controls, women with GDM or IGT tended to be older, had a higher rate of ART treatment, were less likely to be primipara and had a higher rate of multiple pregnancy (table 1). When pregestational cardiovascular risk factors were compared, women with GDM and IGT had a higher rate of obesity and hyperlipidemia compared to controls, but rates of chronic hypertension, ischemic heart disease and cerebrovascular disease were not different. Future diabetes mellitus was diagnosed at a higher rate in women with GDM or IGT (7.0% for GDM, 2.7% for IGT compared with 0.6% for normal GTT, p<.001). Using a survival multivariable analysis (Fig. 1), GDM and IGT were significantly associated with a higher rate of future diabetes (adjusted HR 3.7 for IGT and 12.2 for GDM, P<0.001). In a sub-analysis of the IGT group, all single pathological values were found to be associated with a higher chronic DM rate, though abnormal fasting glucose had the highest rate (8.8% compared with 5.8% for GTT_60, 5.5% for GTT_120 and 6.6% for GTT_180). Our study shows that both IGT and GDM during pregnancy are independently associated with a significant higher rate of future diabetes mellitus, although their effect is influenced by other contributing factors.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Area under the curve during OGTT in first-degree relatives of diabetic patients as an efficient indicator of future risk of type 2 diabetes and prediabetes.

To establish whether the area under the curve of an OGTT has a predictive role in identifying prediabetic and diabetic subjects among first-degree relatives (FDR) of patients with diabetes mellitus type 2 (DM). In a population-based cohort study, 766 FDR of diabetic patients with a normal glucose tolerance test (NGT) completed a 2-hour OGTT. They were followed up for 7years and classified according to the American Diabetes Association criteria into: NGT, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and DM. Relative risk (RR) and 95% confidence intervals (95%CI) were calculated based on logistic regression. Receiver operator characteristic (ROC) analysis along with AUC at different intervals and at time points during the OGTT was used to evaluate the risk of prediabetes and diabetes. Twenty-three subjects (3%) developed type 2 DM, 118 (29.3%) IFG, 81 (11.5%) IGT and 544 (71%) subjects remained NGT. AUC and mean difference of glucose in all high-risk groups demonstrated significant differences in both intervals and time points when compared to the NGT group. The cut-off values during OGTT to predict prediabetes and diabetes was determined as blood glucose more than 7.2 and 7.8mmol/L at 30 and 60minutes, respectively. The time point 60 has the highest predictive role for the development of diabetes, alone, and improved the performance of a prediction model containing multiple important clinical risk factors. The data suggest that the glycaemic response to an OGTT may predict the risk of development of diabetes in first-degree relatives of DM patients.

Comparison of serum calcium and 25-hydroxyvitamin D levels among pregnancies with gestational diabetes mellitues, impaired glucose tolerance and normal glucose tolerance

We aimed to assess the serum calcium and 25-hydroxyvitamin D levels among the pregnant who has gestational diabetes, impaired glucose tolerance and normal glucosetolerance. We included 151 pregnant who underwent oral glucose tolerance test between November 2014 and April 2015. Fasting blood glucose level, oral glucose tolerance test with 50 g of glucose and serum levels of 25-hydroxyvitamin D were performed to whom BMI was ≤30 at between 24-28 weeks of pregnancy. Patients with abnormal response to challenge test underwent standard 100 g, 3-hour oral glucose tolerance test (OGTT). There were three groups as follows: group 1 with impaired glucose tolerance, group 2 gestational diabetes mellitus and group 3 normal glucose levels. Serum levels of 25-hydroxyvitamin D did not demonstrate statistically significant difference between gestational diabetes mellitus, impaired glucose tolerance and normal glucose tolerance groups. There was no statistically significant difference in serum calcium levels between the groups. The main parity was statistically significantly higher in gestational diabetes mellitus group than impaired glucose tolerance and normal glucose tolerance groups. The fasting blood glucose levels of the control group were significantly lower than those of impaired glucose tolerance and gestational diabetes mellitus groups. We did not detect any significant difference between subjects with gestational diabetes, impaired glucose tolerance and normal glucose tolerance test results. Further extensive researches are required to determine the underlying mechanism.