Post-load Plasma Glucose Research Articles

One-Hour Post-Load Plasma Glucose Levels are Associated with Early Arterial Stiffness in Subjects with Different Glucose Tolerance.

ObjectiveThe purpose of this study was to explore the relationship between one-hour post-load plasma glucose levels and early arterial stiffness in subjects with different glucose tolerance.MethodsThis case-control study included 57 subjects with normal glucose tolerance, 38 subjects with pre-diabetes, and 30 subjects with type 2 diabetes. All subjects underwent an oral glucose tolerance test (OGTT) with 75 g of oral anhydrous glucose at 8:00 AM. The brachial-ankle pulse wave velocity (baPWV) was used as a surrogate marker of early arterial stiffness.ResultsbaPWV was significantly higher in the diabetes group than in the normal glucose tolerance group (diabetes group: 1501.8 ± 270.4 cm/s, pre-diabetes group: 1428.6 ± 173.1 cm/s vs normal glucose tolerance group: 1368.0 ± 242.8 cm/s) (p < 0.05). baPWV was positively correlated with age (r = 0.512, p < 0.001), systolic blood pressure (SBP) (r = 0.526, p < 0.001), diastolic blood pressure (DBP) (r = 0.298, p = 0.001), fasting plasma glucose (FPG) (r = 0.213, p = 0.017), 1-h plasma glucose levels from the OGTT (r = 0.407, p < 0.001) and 2-h plasma glucose levels from the OGTT (r = 0.202, p = 0.024). When baPWV was considered as the dependent variable in a multiple regression analysis, the 1-h plasma glucose level from the OGTT maintained an independent association with baPWV (β = 23.129, 95% CI: 8.142–38.115, p = 0.003, R2 = 0.036).ConclusionThe present study demonstrated the presence of early arterial stiffness in diabetes. Elevated 1-hour post-load plasma glucose level is closely related to the change of arterial elasticity in diabetes.

Characteristics of the glycometabolic categories based on the oral glucose tolerance test results in Japanese adults without diabetes.

We aimed to classify Japanese adults without diabetes into different categories based on the oral glucose tolerance test (OGTT) and characterize their insulin sensitivity and insulin secretion. The OGTT was performed on 1,085 Japanese individuals without diabetes (aged 20-64 years); blood glucose and insulin levels were measured at 0, 30-, 60-, 90-, and 120-min. Fasting blood chemistry, hematology, and urine were analyzed. The participants were classified into four categories based on the following: (A) 30 min post-load plasma glucose levels < 157 mg/dL and/or (B) 120 min post-load plasma glucose levels < 126 mg/dL and Matsuda index > 4.97. Category 1 satisfied both conditions, category 2 satisfied condition A but not B, category 3 satisfied condition B but not A, and category 4 satisfied neither condition. Overall, 46%, 21%, 13%, and 20% of the participants were classified into categories 1, 2, 3, and 4, respectively. Compared with category 1, the characteristics of the other categories were: 2, low insulin sensitivity and high blood glucose levels during the later period; 3, low insulin secretion and a rapid increase in blood glucose levels; and 4, combined characteristics of categories 2 and 3. Most blood test values besides glucose metabolism in category 4 were also worse than those in category 1. Categories 1 and 2 had a high proportion of females, whereas categories 3 and 4 had a low proportion. Japanese adults without diabetes are classified into four categories with different insulin sensitivities and insulin secretion using OGTT results. Each category has different characteristics of age and sex distribution and clinical values besides glucose metabolism.

Oxidative Stress and Left Ventricular Performance in Patients with Different Glycometabolic Phenotypes.

The aim of the present study was to evaluate the possible correlation between oxidative stress and subclinical myocardial damage, assessed with speckle tracking echocardiography (STE), in normal glucose tolerance (NGT) patients with one-hour plasma glucose values ≥ 155 mg/dL (NGT ≥ 155), comparing them to NGT < 155 subjects, impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM) newly diagnosed patients. We enrolled 100 Caucasian patients. All subjects underwent OGTT. The serum values of oxidative stress markers (8-isoprostane and Nox-2) were assessed with an ELISA test. Echocardiographic recordings were performed using an E-95 Pro ultrasound system. We observed significant differences, among the four groups, for fasting plasma glucose (p < 0.0001), one-hour postload (p < 0.0001), and two-hour postload plasma glucose (p < 0.0001). As compared with NGT < 155, NGT ≥ 155 exhibited significantly worse insulin sensitivity and higher values of hs-CRP. No significant differences were observed between NGT ≥ 155 and IGT patients. There was a significant increase in 8-isoprostane (p < 0.0001) and Nox-2 (p < 0.0001), from the first to fourth group, indicating an increase in oxidative stress with the worsening of the metabolic status. Serum levels of 8-isoprostane and Nox-2 were significantly increased in NGT ≥ 155 compared to the NGT < 155 group, but similar to IGT. The global longitudinal strain (GLS) appeared progressively lower proceeding from the NGT < 155 to T2DM group (p < 0.0001). For similar values of left ventricular ejection fraction (LVEF), NGT ≥ 155 exhibited reduced GLS compared to NGT < 155 (p = 0.001), but similar to IGT patients. Our study demonstrated that NGT ≥ 155 subjects exhibit early functional impairment of myocardial contractile fibres, these alterations are correlated with increased oxidative stress.

Postload Plasma Glucose but Not Fasting Plasma Glucose Had a Greater Predictive Value for Cardiovascular Disease in a Large Prospective Cohort Study in Southwest China.

BackgroundUncertainty remains regarding the relevance of glycemia, though below the threshold for diabetes, for the risk of cardiovascular disease (CVD) among the Southwest Chinese. We aimed to examine the associations of the first-onset CVD with fasting plasma glucose (FPG) and 2-h postload glucose (2h-PG) in Southwest China.MethodsThe current study examined data from the Guizhou Population Health Cohort Study (GPHCS) of 9,280 participants aged 18 to 95 years recruited from 12 areas since 2010 in Guizhou Province, Southwest China. Participants were followed-up until December, 2020. Primary outcomes were the first onset of a composite of or one of major CVD events, including ischaemic stroke, haemorrhagic stroke and myocardial infarction. FPG, 2h-PG, other metabolic factors and some demographic factors were collected at baseline. Cox proportional hazards models were used to estimate the risk of CVD associated with FPG and 2h-PG. Sensitive analysis and stratified analysis were conducted among participants across different modifiable risk factors and demographic featuresResultsDuring a median of 6.58 years of follow-up, of 7,593 participants with available data for analysis, 174 experienced at least one CVD events, 158 developed stroke (including 126 ischemic stroke and 39 Ischemic stroke events), and 24 developed myocardial infarction. The risk of major CVD events was significantly increased with elevated 2h-PG but not FPG. Compared with participants in the lowest tertile of 2h-PG, those in the highest tertile had a 1.87-fold (95%CI: 1.26–2.77) increased risk for overall CVD, a 1.82-fold (95%CI: 1.20–2.75) increased risk for overall Stroke, and a 1.82-fold (95%CI: 1.20–2.75) increased risk for ischemic stroke, respectively, after adjustment for age, sex, smoking, ethnic group, education level, systolic blood pressure (SBP), triglycerides (TG), body mass index (BMI) and waist circumference (WC). However, there was no relation of glycemia of haemorrhagic stroke or myocardial infarction (P > 0.05). The effect sizes in the associations of CVD with 2h-PG become enhanced among those within normal range of glycemia, SBP, TG, BMI, as well as those without hypertension, dyslipidemia.and obesity.Conclusions2h-PG, in contrast to FPG, is a significant indicator in predication of CVD in Southwest Chinese. Elevated 2h-PG, though below the below the threshold for diabetes, remains independently increased the risk of CVD.

Variability, Mean, and Baseline Values of Metabolic Parameters in Predicting Risk of Type 2 Diabetes.

The effect of baseline (B) and alteration of metabolic parameters (MPs), including plasma glucose (PG) testing, insulin resistance surrogates, and lipid profile and their mutual interactions on the development of type 2 diabetes mellitus (T2DM), has not been investigated systematically. To access the association of the past variability (V), past mean (M), and B values of various MPs and their mutual interaction with the risk of T2DM. A community-based, longitudinal analysis was conducted using the Korean Genome and Epidemiology Study comprising 3829 nondiabetic participants with completed MPs measurements during 3 biannually visits who were followed over the next 10 years. Outcomes included the incidence of T2DM during follow-up. Among predictors, PG concentrations measured during the oral glucose tolerance test were the most prominent T2DM determinants, in which the M of the average value of fasting PG (FPG), 1-hour, and 2-hour PGs had the strongest discriminative power (hazard ratios and 95% CI for an increment of SD: 3.00 (2.5-3.26), AUC: 0.82). The M values of MPs were superior to their B and V values in predicting T2DM, especially among postload PGs. Various mutual interactions between indices and among MPs were found. The most consistent interactants were the M values of high-density lipoprotein cholesterol and the M and V values of FPG. The findings were similar in normal glucose tolerance participants and were confirmed by sensitivity analyses. Postload PG, past alteration of measurements, and mutual interactions among indices of MPs are important risk factors for T2DM development.

Biological and sociocultural determinants of increased blood pressure among women with a history of gestational diabetes mellitus in rural China: a retrospective cohort study

ObjectivesGestational diabetes mellitus (GDM) increases the risk of hypertension and cardiovascular events among mothers later in life. This risk has not been well recognised by healthcare professionals in rural China....

Residual risk associations between initial hyperglycemia and adverse pregnancy outcomes in a large cohort including 6709 women with gestational diabetes

AimsTo estimate the residual risk associations between hyperglycemia and adverse pregnancy outcomes after glycemia-controlling intervention. MethodsAmong 41,067 Chinese women, those with gestational diabetes mellitus (GDM), according to the IADPSG criteria, received standard interventions to control glycemia. Risk associations of plasma glucose (PG) levels with excess newborn birth weight, primary cesarean section, and preterm delivery were estimated and compared with those in the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study, where hyperglycemia was left untreated. ResultsA total of 6,709 (16.3%) women developed GDM and thus received predominantly lifestyle interventions. The incidence of excess newborn birth weight, primary cesarean section, and preterm delivery was 6.1%, 19.1%, and 4.0%, respectively. Higher fasting and higher post-load PG levels during 75-g oral glucose tolerance test (OGTT) were statistically significantly associated with increased risks of excess newborn birth weight and pre-term delivery. Compared with the HAPO study, the association of fasting PG level with excess newborn birth weight showed similar strength and dose-response pattern, contrasting with considerably weakened associations for post-load PG levels that involved glycemic control. Contrary risk associations were seen across GDM subtypes compared with non-GDM, isolated fasting GDM was associated with increased, whereas isolated post-load GDM was associated with decreased, risks of excess newborn birth weight and primary cesarean section. Limiting the analysis to non-GDM women and GDM women with low HbA1c (<6.0%) ≥30 days after interventions overall attenuated the risk associations. ConclusionsResidual risk associations exist between hyperglycemia and adverse pregnancy outcomes despite seemingly appropriate glycemic control.

498 Oxidative stress and left ventricular performance in patients according to different glycometabolic phenotypes

Abstract Recent studies demonstrated that in normoglucose-tolerant subjects (NGT), 1-h post load plasma glucose value ≥155 mg/dL, during OGTT, identifies a worse cardio-metabolic risk profile with increased risk for Type 2 Diabetes Mellitus (T2DM). T2DM patients present increased oxidative stress, due to high blood glucose levels, which plays a central role in the development of CV events. The aim of our study was to evaluate the correlation between oxidative stress and subclinical myocardial damage, assessed with speckle tracking echocardiography, in NGT patients with 1-h post load ≥155 mg/dL vs. NGT &amp;lt; 155 subjects, impaired glucose tolerance (IGT) and T2DM patients. We enrolled 100 Caucasian patients (61 M, 39 W, mean age 61.4 ± 10.7) afferent to CATAMERI study. Main exclusion criteria were CV complications, history of malignant or chronic respiratory disease, alcohol, drug influencing glucose metabolism or smoking abuse. All subjects underwent clinical and laboratory evaluation, OGTT and HOMA-IR. The serum values of the markers of oxidative stress (8-isoprostane and NOX-2) were assessed with ELISA sandwich. Statistical analysis was performed with ANOVA test, linear correlation analysis and stepwise multivariate linear regression model. According to OGTT results, subjects were divided into 4 groups: NGT &amp;lt; 155 (n = 30), NGT ≥ 155 (n = 24), IGT (n = 28), T2DM (n = 18). Serum levels of 8-isoprostane and NOX-2 were significantly increased (P &amp;lt; 0.0001) in NGT ≥ 155 compared to NGT &amp;lt; 155 group, but similar with IGT, indicating an increase in oxidative stress with the worsening of the metabolic status. The left global systolic function, evaluated as myocardial deformation and global longitudinal strain (GLS), appeared progressively lower proceeding from the NGT &amp;lt; 155 group to the T2DM group (P &amp;lt; 0.0001). Moreover, for similar values of ejection fraction (EF), NGT ≥ 155 subjects presented reduced GLS compared to NGT &amp;lt; 155 (P = 0.001), but similar to IGT patients. The linear correlation analysis showed that endo/epi ratio was significantly and inversely correlated with 1 h post load glycaemia (r = −0.632, P &amp;lt; 0.0001), NOX-2 (r = −0.638, P &amp;lt; 0.0001), 8-isoprostane (r = −0.508, P &amp;lt; 0.0001); GLS was inversely correlated with 1 h post load glycaemia (r = −0.734, P &amp;lt; 0.0001) and directly and significantly correlated with 8-isoprostane (r = 0.564, P &amp;lt; 0.0001), NOX-2 (r = 0.625, P &amp;lt; 0.0001). From stepwise multivariate linear regression model, NOX-2 resulted the major predictor of endo/epi ratio, justifying 40.7% of its variation. 1-h post load glycaemia was the second predictor of endo/epi ratio justifying another 9.2% of its variation. Similarly 1-h post load glycaemia was the strongest predictor of the GLS, explaining 53.9% of its variation. Our study demonstrated that NGT ≥ 155 subjects present functional alterations of myocardial contractile fibres, compared to NGT &amp;lt; 155 subjects, but similar to IGT, and these alterations are correlated with oxidative stress. Moreover, GLS is able to identify early alterations in the contractility of subendocardial longitudinal fibres long before the alteration of EF. This data have a central role in ongoing research on the association between hyperglycaemia at 1-h post load and CV risk.

Late-Pregnancy Fetal Hypoxia Is Associated With Altered Glucose Metabolism and Adiposity in Young Adult Offspring of Women With Type 1 Diabetes.

ObjectiveTo investigate associations between exposure to fetal hypoxia and indicators of metabolic health in young adult offspring of women with type 1 diabetes (OT1D).Methods156 OT1D born between 7/1995 and 12/2000 at Helsinki University Hospital, Finland, were invited for follow-up between 3/2019 and 11/2019. A control group of 442 adults born from non-diabetic pregnancies, matched for date and place of birth, was obtained from the Finnish Medical Birth Register. In total, 58 OT1D and 86 controls agreed to participate. All OT1D had amniotic fluid (AF) sampled for erythropoietin (EPO) measurement within two days before delivery in order to diagnose fetal hypoxia. In total, 29 OTID had an AF EPO concentration <14.0 mU/l, defined as normal, and were categorized into the low EPO (L-EPO) group. The remaining 29 OT1D had AF EPO ≥14.0 mU/ml, defined as fetal hypoxia, and were categorized into the high EPO (H-EPO) group. At the age of 18-23 years, participants underwent a 2-h 75g oral glucose tolerance test (OGTT) in addition to height, weight, waist circumference, body composition, blood pressure, HbA1c, cholesterol, triglyceride, high-sensitivity CRP and leisure-time physical activity measurements.ResultsTwo OT1D were diagnosed with diabetes and excluded from further analyses. At young adult age, OT1D in the H-EPO group had a higher BMI than those in the L-EPO group. In addition, among female participants, waist circumference and body fat percentage were highest in the H-EPO group. In the OGTTs, the mean (SD) 2-h post-load plasma glucose (mmol/L) was higher in the H-EPO [6.50 (2.11)] than in the L-EPO [5.21 (1.10)] or control [5.67 (1.48)] offspring (p=0.009). AF EPO concentrations correlated positively with 2-h post-load plasma glucose [r=0.35 (95% CI: 0.07 to 0.62)] and serum insulin [r=0.44 (95% CI: 0.14 to 0.69)] concentrations, even after adjusting for maternal BMI, birth weight z-score, gestational age at birth and adult BMI. Control, L-EPO and H-EPO groups did not differ with regards to other assessed parameters.ConclusionsHigh AF EPO concentrations in late pregnancy, indicating fetal hypoxia, are associated with increased adiposity and elevated post-load glucose and insulin concentrations in young adult OT1D.

One-hour post-load hyperglycemia combined with HbA1c identifies individuals with augmented duodenal levels of sodium/glucose co-transporter 1

AimsIndividuals with HbA1c-defined prediabetes (HbA1c 5.7–6.4%) and 1-hour post-load plasma glucose (1hPG) ≥ 155 mg/dl have an increased risk to develop type 2 diabetes (T2DM). T2DM is associated with a higher intestinal expression of sodium/glucose co-transporter 1 (SGLT-1) and glucose transporter 2 (GLUT-2). It is currently unsettled whether HbA1c-defined dysglycemic conditions combined to 1hPG ≥ 155 mg/dl are associated with changes in SGLT-1 and GLUT-2 duodenal abundance. MethodsSGLT-1 and GLUT-2 protein levels were assessed by western blot on duodenal mucosa biopsies of 57 individuals underwent an upper gastrointestinal endoscopy. ResultsCompared with the normal group (HbA1c < 5.7%), individuals with HbA1c-defined pre-diabetes and diabetes exhibit no significant change in duodenal SGLT-1 abundance. Conversely, duodenal GLUT-2 levels were progressively increased in subjects with prediabetes and diabetes. Stratifying participants according to HbA1c and 1hPG we found that amongst subjects with HbA1c-defined normal or prediabetes condition those having 1hPG ≥ 155 mg/dl displayed higher duodenal levels of SGLT-1 as compared to their counterparts with 1hPG < 155 mg/dl; in contrast to GLUT-2 levels, which were similar between normal and with prediabetes subjects, regardless of 1hPG value. ConclusionA value of 1hPG ≥ 155 mg/dl may identify a subset of individuals within HbA1c-defined glycemic categories having a higher duodenal abundance of SGLT-1.

Acute effects of whole body vibration exercise on post-load glucose metabolism in healthy men: a pilot randomized crossover trial.

PurposeExercise on a whole body vibration (WBV) platform, namely WBV exercise (WBVE), has long-term beneficial effects on glucose metabolism, similarly to conventional moderate-intensity exercise. Conventional moderate-intensity exercise reduces post-load plasma glucose levels at the acute phase. This study aimed to reveal acute effects of WBVE on post-load glucose metabolism.MethodsThis randomized crossover trial enrolled 18 healthy men. They completed the following three interventions in a random order: (1) a 2-hour 75-g oral glucose tolerance test (OGTT) without WBVE (OGTT-alone), (2) 20-minute WBVE before an OGTT (WBVE → OGTT), and (3) 20-minute WBVE during an OGTT (OGTT → WBVE). Post-load glucose metabolism in the WBVE → OGTT and OGTT → WBVE interventions were compared with that in the OGTT-alone intervention.ResultsPlasma glucose levels in the WBVE → OGTT and OGTT → WBVE interventions were not significantly different from those in the OGTT-alone intervention at any time point except 15 min, wherein the WBVE → OGTT intervention had higher glucose levels (111 [interquartile range, 102–122] mg/dL vs 122 [111–134] mg/dL, P = 0.026). Higher plasma glucagon levels were observed at 0 min in the WBVE → OGTT intervention and at 60 min in the OGTT → WBVE intervention (P = 0.010 and 0.015). Cortisol, Growth hormone, and adrenaline levels were significantly increased after WBVE, whereas noradrenaline levels were not. Serum insulin levels in the WBVE → OGTT intervention were significantly higher than those in the OGTT-alone intervention at 0 min (P = 0.008).ConclusionsWBVE did not decrease post-load plasma glucose levels at the acute phase. Acute effects of WBVE on post-load glucose metabolism would not be identical to those of conventional exercise.The unique trial number and the name of the registry: UMIN000036520, www.umin.ac.jp, date of registration, June 12, 2019.

One-Hour Postload Plasma Glucose in Obese Indian Adults with Nonalcoholic Fatty Liver Disease: An Observational Study from North India.

Background:Metabolic perturbations and hyperglycemia are increasingly identified as causal factors for nonalcoholic fatty liver disease (NAFLD). Insulin resistance, an indirect marker for initiation of NAFLD can be promptly diagnosed with standard oral glucose tolerance test (OGTT). One-hour postOGTT plasma glucose measurement can have a significant impact on early identification of dysglycemia with NAFLD and may be superior to fasting and 2-hour plasma glucose.Objective:To assess 1-hour post OGTT plasma glucose levels and presence of NAFLD in obese adults.Materials and Methods:In this observational study, we included 101 consecutive obese (body mass index >25 kg/m2) participants of age 20–50 years without known illness of diabetes mellitus. Their anthropometric and laboratory characteristics were recorded and a standard OGTT was performed. Plasma glucose (PG) levels were measured during fasting, 1-hour (1-hour-PPG), and 2-hour (2-hour-PPG) intervals. All participants underwent ultrasound of the abdomen by a single, experienced observer for fatty liver (FL) grade assessment. Comparison of the PG and FL was done by the Chi-square test and a P value <0.05 was considered statistically significant with a 95% confidence interval. Data analysis was done using SPSS version 24.0 (IBM® SPSS Statistics Inc., Chicago, Illinois, USA).Results:The result demonstrated that 53 adults had 1-hour-PPG values above the cutoff (≥155 mg/dl), whereas only 20 individuals had raised PG at 2 hours (≥140 mg/dl). All study subjects (100%) had an evidence of FL disease on ultrasound scan. Among these, 33 had grade I and 68 participants had grade II or III FL. About 41.6% of individuals had deranged 1-hour-PPG levels and higher FL grades as compared to 11.9% individuals with raised 2-hour-PPG values and FL of same grades. The relationship between 1-hour-PPG and FL grades was also statistically significant (P value <0.05).Conclusions:1-hour-PPG levels were more deranged in obese adults without diabetes, and had more consistent and significant relationship with higher FL grades than the 2-hour-PPG levels.

High concentrations of triglycerides are associated with diabetic kidney disease in new-onset type 2 diabetes in China: Findings from the China Cardiometabolic Disease and Cancer Cohort (4C) Study.

AimsThe aims of this study were to evaluate the associations of metabolic abnormalities with incident diabetic kidney disease (DKD) and to explore whether dyslipidaemia, particularly high fasting triglyceride (TG), was associated with the development of DKD.MethodsIn total, 11 142 patients with new‐onset type 2 diabetes with baseline estimated glomerular filtration rates (eGFR) ≥60 mL/min/1.73 m2 were followed up during 2011‐2016. Incident DKD was defined as eGFR <60 mL/min/1.73 m2 at follow‐up. Multiple logistic regression analysis was conducted to explore the relationship of metabolic abnormalities at baseline and at follow‐up with risks of DKD. High TG was defined by TG ≥1.70 mmol/L. Low high‐density lipoprotein cholesterol (HDL‐c) was defined by HDL‐c <1.0 mmol/L for men or <1.3 mmol/L for women.ResultsParticipants who developed DKD had higher levels of waist circumference and systolic blood pressure, and lower levels of HDL‐c at both baseline and follow‐up visits. The DKD group also had higher levels of post‐load plasma glucose and TG at follow‐up. Multivariate logistic regression analysis revealed that both high TG at baseline [odds ratio (OR) = 1.37, p = .012) and high TG at follow‐up (OR = 1.71, p < .001) were significantly associated with increased risks of DKD. Patients with high TG levels at both baseline and follow‐up had higher risk of DKD compared with constantly normal TG (OR = 1.65, p < .001) after adjustment for covariates.ConclusionsIn a large population of patients with new‐onset type 2 diabetes, a high TG level was an independent risk factor for the development of DKD. Tight TG control might delay the occurrence of DKD.

Association between prediabetes definition and progression to diabetes: The REDIA follow-up study

Aim To determine which prediabetes definition is the best predictor of progression to diabetes in Reunion Island where 10% of the population has treated diabetes.Methods This follow-up study used data from the REDIA cross-sectional study, a population-based study conducted in two stages. Participants were enrolled in 1999–2001 (REDIA-1) and followed-up years later in 2006–2009 (REDIA-2). Odds ratios (OR) for prediabetes were estimated with their 95% confidence interval (95%CI) from logistic regression models. REDIA-1 participants with no previously identified diabetes in REDIA-1 were assessed for new pharmacologically treated diabetes in REDIA-2. We evaluated several biological definitions of prediabetes, each based on the combination of fasting plasma glucose (FPG), 2-h post-load plasma glucose (2hPG), and/or HbA1c: FPG-ADA (American Diabetes Association), FPG-WHO (World Health Organization), 2hPG, HbA1c-ADA, HbA1c-IEC (International Expert Committee), FPG-WHO/2hPG, and FPG-WHO/HbA1c-ADA.Results A total of 432 participants met all inclusion criteria. Of these, 102 (23.6%) were classified as prediabetic using the FPG-WHO/2hPG definition, including 58 (56.9%) with isolated impaired glucose tolerance, 17 (16.6%) with isolated impaired fasting glucose, and 27 (26.5%) with both impairments. A total of 54 (12.5%) participants became treated diabetics and in descending order, the ORs for the FPG-WHO/2hPG, 2hPG, FPG-WHO, FPG-WHO/HbA1c-ADA, FPG-ADA, HbA1c-ADA, and HbA1c-IEC definitions were 6.96 [3.72–13.03], 5.91 [3.24–10.77], 5.82 [2.86–11.81], 4.68 [2.38–9.19], 4.37 [2.34–8.17], 3.24 [1.72–6.10], and 2.74 [1.32–5.70], respectively.Conclusion The FPG-WHO/2hPG definition had the highest strength of association with the progression to treated diabetes, closely followed by the 2hPG and FPG-WHO definitions. Our findings highlight the importance of performing both FPG test and OGTT to diagnose prediabetes in primary care.

Associations Between Fruit Intake and Risk of Diabetes in the AusDiab Cohort.

ContextFruit, but not fruit juice, intake is inversely associated with type 2 diabetes mellitus (T2DM). However, questions remain about the mechanisms by which fruits may confer protection.ObjectiveThe aims of this work were to examine associations between intake of fruit types and 1) measures of glucose tolerance and insulin sensitivity and 2) diabetes at follow-up.MethodsAmong participants of the Australian Diabetes, Obesity and Lifestyle Study, fruit and fruit juice intake was assessed by food frequency questionnaire at baseline. Associations between fruit and fruit juice intake and 1) fasting plasma glucose, 2-hour postload plasma glucose, updated homeostasis model assessment of insulin resistance of β-cell function (HOMA2-%β), HOMA2 of insulin sensitivity (HOMA2-%S), and fasting insulin levels at baseline and 2) the presence of diabetes at follow-up (5 and 12 years) were assessed using restricted cubic splines in logistic and linear regression models.ResultsThis population of 7675 Australians (45% males) had a mean ± SD age of 54 ± 12 years at baseline. Total fruit intake was inversely associated with serum insulin and HOMA2-%β, and positively associated with HOMA2-%S at baseline. Compared to participants with the lowest intakes (quartile 1), participants with moderate total fruit intakes (quartile 3) had 36% lower odds of having diabetes at 5 years (odds ratio, 0.64; 95% CI, 0.44-0.92), after adjusting for dietary and lifestyle confounders. Associations with 12-year outcomes were not statistically significant.ConclusionA healthy diet including whole fruits, but not fruit juice, may play a role in mitigating T2DM risk.

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.

Clinical Utility of 30-Min Postload Plasma Glucose in Paediatric Obesity

Introduction: Intermediary glucose measurements at other time points in a standard 2-hour oral glucose tolerance test (OGTT) is increasingly being investigated, and a number of studies have demonstated strong predictive value of 1-hour plasma glucose (PG) in identifying subjects with high risk of future diabetes and vascular complications. The association between 30-minute PG and incidence of diabetes is less extensively studied and all the suggested 30-minute PG cutoff values in current literature are derived from adult population. Our study aimed to evaluate the optimal cutoff value of 30-minute PG in predicting abnormal OGTT (prediabetes/diabetes) in a cohort of paediatric subjects with overweight or obesity. Since 30-minute PG could be easily performed even in a busy clinic setting, such cutoff allows clinicians identify high risk subjects who should proceed to a 2-hour OGTT. Methods: Record of 332 paediatric subjects with overweight/obesity who had OGTT done in a tertiary unit from January 2012 to December 2018 was reviewed. Standard OGTT was performed and blood samples for PG and insulin were obtained at 0 minute, 30 minutes and 120 minutes. Subjects with prediabetic and diabetic response were considered together as a group (abnormal OGTT group) for statistical analysis. 30-min PG and insulinogenic index (IGI) were compared, and 30-min PG cutoff which predicts abnormal OGTT response was derived. Results: Our cohort consists of 97.3% Chinese with mean age of 15.4 ± 2.3 years and mean BMI z-score of 2.7 ± 0.6. Sixty subjects (18.1%) had abnormal OGTT – out of which 47 (14.2%) and 13 (3.9%) had prediabetes and diabetes range of glycaemic response respectively. 30-minute PG was statistically higher in the abnormal OGTT group compared to the normal OGTT group (9.6 vs 7.9 mmol/L, p=0.001). IGI was statistically lower in the abnormal OGTT group compared to the normal group (262.1 vs 377.2, p=0003). 30-min PG ≥ 9.2 mmol/L predicts abnormal OGTT with best combination of sensitivity and specficity (AUC 0.77, sensitivty 62.1%, specificity 83.7%). Conclusion: Children with abnormal OGTT reseponse showed impaired first phase insulin secretion suggestive of beta-cell loss. Instead of performing a 2-hour OGTT in every child referred for obesity, 30-min PG, with a cutoff value of 9.2mmol/L, could be used as a stratification tool in identifying high risk subjects who should return for a 2-hour OGTT in another visit.

ELEVATED ONE-HOUR POSTLOAD PLASMA GLUCOSE LEVELS IDENTIFY CORONARY HEART DISEASE PATIENTS WITH GREATER SEVERITY OF CORONARY ARTERY LESIONS AND HIGHER RISK OF ONE-YEAR RE-ADMISSION

Objective: To investigate the relationship of one-hour postload plasma glucose (1-h PG) during the oral glucose tolerance test (OGTT) with the severity of coronary artery lesions and risk of one-year re-admission with adverse cardiovascular events in coronary heart disease (CHD) patients with normal glucose tolerance (NGT). Design and method: 266 consecutive CHD patients who underwent coronary angiography and had NGT confirmed by OGTT during hospitalization were prospectively enrolled and followed in two groups according to the 1-h PG cut-off point of 155 mg/dL (1-h PG&lt;155 mg/dL, n = 149 and elevated 1-h PG levels, n = 117). Angiographic severity was assessed by number of diseased vessels, lesion morphology and Gensini score. The risk of one-year re-admission with adverse cardiovascular events after discharge was analysed using Kaplan-Meier analysis. Results: Subjects with elevated 1-h PG levels had higher incidence of multi-vessel disease and complex lesions (76.9% vs 47.7%,P &lt; 0.001 and 48.7% vs 32.2%,P = 0.002), Gensini score [60(33–88) vs 28(16–44), P &lt; 0.001], and risk of one-year re-admission (19.8 vs 8.9%,Breslow test P = 0.016) than subjects with a 1-h PG&lt;155 mg/dL. In the stepwise multivariate regression analysis, the variable that remained significantly associated with the Gensini score was 1-h PG accounting for 13.1% of its variation. Subgroup analyses by sex showed that men with elevated 1-h PG levels had higher incidence of complex lesions (46.8% vs 32.1%, P = 0.033) and risk of one-year re-admission (19.9 vs 8.9%, Breslow test P = 0.031) than men with a 1-h PG&lt;155 mg/dL, but this trend was not seen in women. Figure 1. Kaplan–Meier curves showing the cumulative risk of one-year re-admission with adverse cardiovascular events after discharge in all subjects and stratified by sex. Conclusions: CHD patients with NGT and elevated 1-h PG levels had a greater severity of coronary artery lesions and an increased risk of re-admission with adverse cardiovascular events, particularly in men.

Diversity in the risk of type 2 diabetes associated with age, sex, and 1-h post-load plasma glucose levels in the Japanese population with prediabetes

AimsWe investigated the risk of type 2 diabetes in the Japanese population with prediabetes, focusing on prediabetes categories, age- and sex-related differences, and plasma glucose levels during a 75-g oral glucose tolerance test. MethodsThis retrospective cohort study included 11,414 participants (5330, 2560, 1501, and 2023 with normal fasting glucose/normal glucose tolerance, isolated impaired fasting glucose [IFG], isolated impaired glucose tolerance [IGT], and IFG plus IGT, respectively). The risk of type 2 diabetes was stratified by age and sex. Moreover, prediabetes was subdivided according to fasting plasma glucose (FPG) and 1-h post-load glucose levels. ResultsOver a mean 6.3-year follow-up period, 1002 participants developed type 2 diabetes. The risk of type 2 diabetes was higher in isolated IFG than isolated IGT in elderly participants, but not in middle-aged participants. A higher risk was evident in isolated IFG in women, but not men. Moreover, about a 27- and 29-fold difference exists in men and women, respectively, in the risk of type 2 diabetes among the subdivided prediabetes categories. ConclusionThe assessment of age and sex-differences and subdivided prediabetes categories based on FPG and 1-h post-load glucose levels may effectively evaluate the risk of type 2 diabetes, which displays marked diversity.

Associations of progression to diabetes and regression to normal glucose tolerance with development of cardiovascular and microvascular disease among people with impaired glucose tolerance: a secondary analysis of the 30 year Da Qing Diabetes Prevention Outcome Study

We aimed to determine associations of regression to normal glucose tolerance (NGT), maintaining impaired glucose tolerance (IGT) or progression to diabetes with subsequent risks of CVD and microvascular disease among Chinese adults with IGT. We conducted an observational study among 540 participants in the Da Qing Diabetes Prevention Study, a 6year lifestyle intervention trial in people with IGT, defined by 1985 WHO criteria as fasting plasma glucose <7.8mmol/l and 2h post-load plasma glucose ≥7.8 and <11.1mmol/l. At the end of the trial, the groups that had regressed to NGT, remained with IGT or progressed to diabetes were identified. Participants were then followed for 24years after completion of the trial, during which we compared the incidence and hazard ratios for CVD and microvascular disease in each group and estimated the differences in their median time to onset from parametric Weibull distribution models. At the end of the 6year trial, 252 (46.7%) participants had developed diabetes, 114 (21.1%) had remained with IGT and 174 (32.2%) had regressed to NGT. Compared with those who developed diabetes during the trial, the median time to onset of diabetes was delayed by 14.86years (95% CI 12.49, 17.25) in the NGT and 9.87years (95% CI 8.12, 11.68) in the IGT groups. After completion of the trial, among those with diabetes, IGT and NGT, the 24year cumulative incidence of CVD was 64.5%, 48.5% and 45.1%, respectively, and 36.8%, 21.7% and 16.5% for microvascular diseases. Compared with participants who had progressed to diabetes during the trial, those who regressed to NGT had a 37% (HR 0.63; 95% CI 0.47, 0.85) reduction in CVD incidence and a median delay of 7.45years (95% CI 1.91, 12.99) in onset, and those who remained with IGT had a 34% (HR 0.66; 95% CI 0.47, 0.91) lower CVD incidence with a median delay in onset of 5.69years (95% CI 1.0, 10.38). Participants with NGT had a 66% (HR 0.34; 95% CI 0.20, 0.56) lower incidence of microvascular diseases and a median delay in the onset of 18.66years (95% CI 6.08, 31.24), and those remaining with IGT had a 52% (HR 0.48; 95% CI 0.29, 0.81) lower incidence with a median delay of 12.56years (95% CI 2.49, 22.63). People with IGT who reverted to NGT or remained with IGT at the end of the 6year trial subsequently had significantly lower incidences of CVD and microvascular disease than those who had developed diabetes.