Lessons learned from the 1‐hour post‐load glucose level during OGTT: Current screening recommendations for dysglycaemia should be revised |
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| Authors: | Michael Bergman Ram Jagannathan Martin Buysschaert Manan Pareek Michael H Olsen Peter M Nilsson José Luis Medina Jesse Roth Angela Chetrit Leif Groop Rachel Dankner |
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| Institution: | 1. Division of Endocrinology and Metabolism, Department of Medicine and of Population Health, School of Medicine, NYU Langone Diabetes Prevention Program, New York, NY, USA;2. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA;3. Department of Endocrinology and Diabetology, Université Catholique de Louvain, University Clinic Saint‐Luc, Brussels, Belgium;4. Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Odense, Denmark;5. Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark;6. Department of Clinical Sciences and Lund University Diabetes Centre, Lund University, Sk?ne University Hospital, Malm?, Sweden;7. Oporto Medical School, Oporto University, Oporto, Portugal;8. The Feinstein Institute for Medical Research, Manhasset, NY, USA;9. Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel;10. Lund University Diabetes Centre, Lund University, Malm?, Sweden;11. Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel |
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| Abstract: | This perspective covers a novel area of research describing the inadequacies of current approaches for diagnosing dysglycaemia and proposes that the 1‐hour post‐load glucose level during the 75‐g oral glucose tolerance test may serve as a novel biomarker to detect dysglycaemia earlier than currently recommended screening criteria for glucose disorders. Considerable evidence suggests that a 1‐hour post‐load plasma glucose value ≥155 mg/dl (8.6 mmol/L) may identify individuals with reduced β‐cell function prior to progressing to prediabetes and diabetes and is highly predictive of those likely to progress to diabetes more than the HbA1c or 2‐hour post‐load glucose values. An elevated 1‐hour post‐load glucose level was a better predictor of type 2 diabetes than isolated 2‐hour post‐load levels in Indian, Japanese, and Israeli and Nordic populations. Furthermore, epidemiological studies have shown that a 1‐hour PG ≥155 mg/dl (8.6 mmol/L) predicted progression to diabetes as well as increased risk for microvascular disease and mortality when the 2‐hour level was <140 mg/dl (7.8 mmol/L). The risk of myocardial infarction or fatal ischemic heart disease was also greater among subjects with elevated 1‐hour glucose levels as were risks of retinopathy and peripheral vascular complications in a Swedish cohort. The authors believe that the considerable evidence base supports redefining current screening and diagnostic recommendations with the 1‐hour post‐load level. Measurement of the 1‐hour PG level would increase the likelihood of identifying a larger, high‐risk group with the additional practical advantage of potentially replacing the conventional 2‐hour oral glucose tolerance test making it more acceptable in a clinical setting. |
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| Keywords: | diabetes HbA1c impaired fasting glucose impaired glucose tolerance oral glucose tolerance test prediabetes |
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