1-hour blood glucose level is a stronger predictor of future T2D than the 2-hour level
A recently published article in Diabetes Care (November 2017) by former Danish Diabetes Academy PhD fellow Manan Pareek, now postdoctoral research fellow at Brigham and Women’s Hospital in Boston, discusses whether the 1-h blood glucose measurement would be a more suitable screening tool for assessing the risk of diabetes and its complications than the 2-h measurement.
PREDICTING AND PREVENTING TYPE 2 DIABETES
Type 2 diabetes can be prevented with lifestyle modification and drug therapy, which makes identifying high-risk individuals important. Traditionally, prediabetes has been defined as impaired fasting glucose or impaired glucose tolerance during a 2-hour oral glucose tolerance test (OGTT). However, not all subjects with prediabetes develop type 2 diabetes, while a significant number without prediabetes progresses to type 2 diabetes. The 1-hour postload glucose level during OGTT with a cut-off ≥ 8.6 mmol/L may be an early marker of impaired glucose tolerance and subsequent type 2 diabetes.
THE 1-HOUR ORAL GLUCOSE TOLERANCE TEST
We conducted a registry-based, prospective, population-based cohort study of 4,867 men born between 1921-1949 who were participants of the Swedish Malmö Preventive Project. These men underwent OGTT with blood glucose measurements at multiple time points, including 0, 1, and 2 hours, and were followed for up to 39 years, during which 636 cases of type 2 diabetes were detected. We found that the 1-hour glucose level (≥ 8.6 mmol/L) was a stronger predictor of future type 2 diabetes than the 2-hour level (≥ 7.8 mmol/L) and provided greater net reclassification improvement in subjects stratified into a low- and a high-risk category according to the absence or presence of impaired fasting glucose. Subjects with elevated 1-hour blood glucose levels had greater risks of all-cause mortality, myocardial infarction or fatal ischemic heart disease, retinopathy, and peripheral vascular complications, respectively.
CLINICAL PERSPECTIVES
Accumulating evidence suggests that a shortened oral glucose tolerance test is a very useful marker of risk. Targeting individuals with an elevated 1-hour blood glucose level has the potential to substantially reduce cardiometabolic burden, particularly considering its high sensitivity. An important next step would be to examine, preferably in a randomized setting, whether such a strategy is clinically beneficial and cost-effective.
SUMMARY
The 1-hour blood glucose level is a stronger predictor of future type 2 diabetes than the 2-hour level and is associated with diabetes complications and mortality.
AUTHORS AND AFFILIATIONS
Manan Pareek1,2,3; Deepak L. Bhatt1; Mette L. Nielsen2; Ram Jagannathan4; Karl-Fredrik Eriksson5; Peter M. Nilsson5; Michael Bergman6; Michael H. Olsen2,3.
1Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, United States
2Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark
3Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
4NYU School of Medicine, Department of Population Health, Center for Healthful Behavior Change, New York, NY, United States
5Department of Clinical Sciences and Lund University Diabetes Centre, Lund University, Skåne University Hospital, Malmö, Sweden
6NYU School of Medicine, Department of Medicine, Division of Endocrinology and Metabolism, NYU Langone Diabetes Prevention Program, New York, NY, United States
Source: Diabetes Care