Lessons learned from the 1‐hour post‐load glucose level during OGTT: Current screening recommendations for dysglycaemia should be revised

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 HbA 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.

One‐hour post‐load plasma glucose predicts progression to prediabetes in a multi‐ethnic cohort of obese youths

“…7 Compared with the rest of the cohort, those youths showed a less favourable clinical and metabolic phenotype, characterized by increased age-and sex-adjusted BMI, a less favourable lipid In this context, 1hPG has been proposed recently as an earlier, more sensitive and accurate predictor of prediabetes and diabetes than currently used biomarkers. 10 While several longitudinal studies have confirmed the ability of 1hPG to predict diabetes and its micro-and macrovascular complications in adults, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]26 there is only a single longitudinal study available in the paediatric population. 27 Our results extend the findings of that study, in that we analysed data from a larger and more heterogeneous cohort of youths, and we used a lower cut point to identify 1-hour hyperglycaemia.…”

“…In adults, several longitudinal studies have recently identified 1‐hour post‐load glucose concentration (1hPG) during an oral glucose tolerance test (OGTT) as an earlier and more accurate predictor of diabetes than currently used biomarkers . In 2007, Abdul‐Ghani et al found that the area under the ROC curve for 1hPG to predict future diabetes is significantly greater than that of fasting and 2‐hour plasma glucose.…”

“…In adults, several longitudinal studies have recently identified 1hour post-load glucose concentration (1hPG) during an oral glucose tolerance test (OGTT) as an earlier and more accurate predictor of diabetes than currently used biomarkers. [10][11][12][13][14][15][16][17][18][19][20] In 2007, Abdul-Ghani et al 10 found that the area under the ROC curve for 1hPG to predict future diabetes is significantly greater than that of fasting and 2-hour plasma glucose. Thereafter, elevated 1hPG has been consistently reported to be associated with impaired insulin sensitivity, reduced β-cell function and a less favourable cardiometabolic risk profile.…”

The contribution of unrecognized factors to the diabetes epidemic

“…To identify high‐risk individuals with subtle glucose abnormalities earlier when improvement in β‐cell function is more probable with intervention, novel biomarkers with higher sensitivity are required. The 1‐hour plasma glucose (1‐hour PG) ≥155 mg/dL (8.6 mmol/L) during the OGTT has been extensively reviewed and found to be more sensitive than HbA1c or glucose criteria in those with normal glucose tolerance (NGT) for predicting progression to type 2 diabetes, microvascular and macrovascular complications, and mortality 19–23 . Considerable epidemiologic evidence derived from different populations strongly suggests that an elevated 1‐hour PG level may be preferred to current screening tests for identifying high‐risk individuals when ß‐cell function is intact.…”

A Novel Synthetic Model of the Glucose-Insulin System for Patient-Wise Inference of Physiological Parameters From Small-Size OGTT Data

“…Typically, such measurements take place at time 0 (fasting) and 2 h after the ingestion of glucose, but more temporal resolution might be required, or other physiological variables measured, depending on how strict clinical criteria are. Moreover, efforts have been made to modify and standardize the temporal resolution and duration of the tests (Bergman et al, 2018). Besides the clinical interpretation of the OGTT and MT values, some model-derived indexes can be obtained, as is the case of the Insulin Sensitivity S I , derived from the very well known Minimal Model (Bergman et al, 1979).…”