Two-hour Glucose Values Research Articles

Alcohol use and dysglycemia among people living with human immunodeficiency virus (HIV) in the Alcohol & Metabolic Comorbidities in PLWH: Evidence Driven Interventions (ALIVE-Ex) study.

At-risk alcohol use is a common and costly form of substance misuse that is highly prevalent among people living with HIV (PLWH). The goal of the current analysis was to test the hypothesis that PLWH with at-risk alcohol use are more likely to meet the clinical criteria for prediabetes/diabetes than PLWH with low-risk alcohol use. A cross-sectional analysis was performed on measures of alcohol and glycemic control in adult PLWH (n=105) enrolled in a prospective, interventional study (the ALIVE-Ex Study (NCT03299205)) that investigated the effects of aerobic exercise on metabolic dysregulation in PLWH with at-risk alcohol use. The Alcohol Use Disorders Identification Test (AUDIT), Timeline Followback, and phosphatidylethanol (PEth) level were used to measure alcohol use. Participants were stratified into low-risk (AUDITscore <5) and at-risk alcohol use (AUDIT score≥5). All participants underwent an oral glucose tolerance test and measures of glycemic control- the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and Matsuda Index - were correlated with alcohol measures and compared by AUDIT score group using mixed-effects linear and logistic regression models, adjusting for age, sex, race, body mass index (BMI), and viral load. In response to the glucose challenge, participants with at-risk alcohol use (n=46) had higher glucose levels and were five times more likely to meet criteria for prediabetes/diabetes (OR: 5.3 (1.8, 15.9)) than participants with an AUDIT score<5. Two-hour glucose values were positively associated with AUDIT score and PEth level and a higher percentage of PLWH with at-risk alcohol use had glucose values ≥140mg/dl than those with low-risk alcohol use (34.8% vs. 10.2%, respectively). In this cohort of PLWH, at-risk alcohol use increased the likelihood of meeting the clinical criteria for prediabetes/diabetes (2-h glucose level ≥140mg/dl). Established determinants of metabolic dysfunction (e.g., BMI, waist-hip ratio) were not associated with greater alcohol use and dysglycemia, suggesting that other mechanisms may contribute to the impaired glycemic control observed in this cohort.

Is it suitable for DM diagnosis using an abnormal two-hour glucose value only after 24th gestational weeks in China

Objective To investigate the postnatal outcomes of diabetes mellitus (DM) women diagnosed according to two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks in China, and to evaluate if it is suitable for DM diagnosis using the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks only. Research design and methods: We conducted a retrospective cohort study of the pregnant women with gestational hyperglycemia participated in gestational hyperglycemia day care and delivered in Peking University First Hospital from June 2016 to May 2018. A total of 168 women diagnosed with DM according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks were included, and 75 DM women did the oral glucose tolerance test (OGTT) from 6 weeks to 1 year postpartum. The general information collected and analyzed included age, prepregnancy body mass index (BMI), prepregnancy weight, gestational weight gain (GWG), OGTT value during pregnancy, OGTT value of postpartum, gestational weeks, and neonatal birth weight. Results There were 168 women diagnosed with DM according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks, and 75 (75/168, 44.6%) women underwent an OGTT from 6 weeks to 1 year postpartum. Among the women followed-up, 56 (56/75, 74.7%) women were diagnosed as hyperglycemia and 19 (19/75, 25.3%) women were diagnosed as normal glucose metabolism. In hyperglycemia women, there are eight (8/56, 10.7%) women diagnosed as DM, 24 (24/56, 32.0%) women diagnosed as impaired glucose tolerance (IGT), eight (8/56, 10.7%) women diagnosed as impaired fasting glucose (IFG), and 16 (16/56, 21.3%) women diagnosed as IFG and IGT. Compared with normal glucose metabolism women, the age of hyperglycemia women is higher significantly (34.8 ± 3.8 versus 32.7 ± 4.7). The incidence of IFG, pharmacy treatment, and the value of HbA1c is also higher in hyperglycemia women than the normal glucose metabolism women, in which it is not statistically significant but clinically significant. Conclusion In DM women diagnosed according to the criteria that two-hour glucose value ≥11.1 mmol/L after 24th gestational weeks, there were only eight (10.7%) women could meet DM diagnostic criteria according to the OGTT value of postpartum. Moreover, 25% women had normal OGTT value postpartum. Due to the characteristics of glucose metabolism in Asian population, an abnormal two-hour glucose value in OGTT may not be suitable to diagnose DM during pregnancy in China.

NICE challenge on postnatal reclassification of glucose tolerance in women previously diagnosed with gestational diabetes mellitus

AbstractWomen with a history of gestational diabetes mellitus (GDM) are at increased risk of developing diabetes. National Institute for Health and Clinical Excellence guidelines (July 2008) recommend the use of fasting plasma glucose (FPG) but not an oral glucose tolerance test (OGTT) at the six‐week postnatal check. Our data analysis aims to challenge this recommendation.Retrospective data were obtained for 95 women with GDM who delivered at Queen Mary's Hospital, Sidcup, UK (2003–2008). The results of the FPG concentration were assessed in relation to the two‐hour glucose value.Of the 95 OGTTs, the two‐hour glucose value revealed that seven had diabetes and 19 had impaired glucose tolerance (IGT). However, 12 women had IGT and one had diabetes with a normal FPG (&lt;6.0mmol/L). The sensitivity and specificity of using FPG for the diagnosis of postnatal diabetes are 85.7% and 87.5%, respectively.In our population, using a six‐week postnatal FPG is unsatisfactory for evaluating the glucose tolerance of women with previous GDM as it would result in failure to diagnose 63.2% of those with IGT and a smaller proportion of those with diabetes. It is established that lifestyle changes can reduce the incidence of diabetes in individuals with IGT. For this reason, the OGTT remains the preferred option for the postnatal follow up of women with previous GDM in our hospital. Copyright © 2010 John Wiley &amp; Sons.

Bimodality of fasting and two-hour glucose tolerance distributions in a Micronesian population.

While frequency distributions of glucose concentrations in Caucasian populations are unimodal, bimodality has been described in the Pima Indians, a population with an extremely high prevalence of diabetes. Venous plasma glucose concentrations at fasting and after a 75-gm. oral glucose load were determined in 596 Nauruans, a Micronesian population with a diabetes prevalence of the same order as the Pima Indians. In both sexes and in subjects 10 to 19 years, the frequency distributions of the logarithms of the fasting and two-hour glucose values were clearly unimodal. In most sex and age groups of 20 years and older, the frequency distributions of fasting and two-hour glucose values were bimodal and consistent with a model of two overlapping Gaussian distributions. This population is characterized by marked obesity. However, there was no significant difference in the degree of obesity between subjects in the first and second curves of the bimodal distribution. This makes it unlikely that the bimodality is a consequence of the marked obesity seen in both the Pima and Nauru populations. The data show that among Nauruans, as with the Pimas, the frequency distribution of glucose concentrations can be used to separate the population into normal and hyperglycemic groups.