Profiles of Glucose Metabolism in Different Prediabetes Phenotypes, Classified by Fasting Glycemia, 2-Hour OGTT, Glycated Hemoglobin, and 1-Hour OGTT: An IMI DIRECT Study

Tura, Andrea; Grespan, Eleonora; Göbl, Christian; Koivula, Robert W.; Franks, Paul W.; Pearson, Ewan R.; Walker, Mark; Forgie, Ian; Giordano, G; Pávó, Imre; Ruetten, Hartmut; Dermitzakis, Emmanouil T.; McCarthy, Mark; Pedersen, Oluf; Schwenk, Jochen M.; Adamski, Jerzy; Masi, Federico De; Tsirigos, Konstantinos D.; Brunak, Søren; Viñuela, Ana; McDonald, Timothy J.; Kokkola, Tarja; Vangipurapu, Jagadish; Cederberg, Henna; Laakso, Markku; Rutters, Femke; Elders, Petra; Koopman, Anitra D.M.; Beulens, Joline W.J.; Ridderstråle, Martin; Hansen, Torben; Allin, Kristine H.; Hansen, Torben; Vestergaard, Henrik; Mari, Andrea

doi:10.2337/db21-0227

Cited by 21 publications

(19 citation statements)

References 42 publications

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“…Individuals with both IFG and IGT, develop T2DM sooner than those with isolated defects. (44) In our study, postpartum HbA1c overestimated the number of women with T2DM, incorrectly classifying 12 women with OGTT prediabetes and three with OGTT normoglycemia as having T2DM, based on OGTT criteria. Most (7/12) of the women diagnosed with OGTT prediabetes had both IFG and IGT on OGTT.…”

Section: Discussioncontrasting

confidence: 49%

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Early postpartum HbA1c after hyperglycemia first detected in pregnancy - imperfect but not without value

Coetzee

Hall

Vyver

et al. 2023

Preprint

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Background: South African women of childbearing age are disproportionally affected by obesity and at significant risk of Type 2 Diabetes Mellitus (T2DM). Unless pregnant, they do not readily undergo screening for T2DM. With a local focus on improved antenatal care, hyperglycemia is often first detected in pregnancy (HFDP). This may erroneously be attributed to Gestational Diabetes Mellitus (GDM) in all without considering T2DM. Glucose evaluation following pregnancy is essential for early detection and management of women with T2DM in whom persistent hyperglycemia is to be expected. Conventional testing with an oral glucose tolerance test (OGTT) is cumbersome, prompting investigation for alternate solutions. Aim: To compare the diagnostic performance of HbA1c to the current gold standard OGTT in women with HFDP 4-12 weeks post-delivery. Methods: Glucose homeostasis was assessed with OGTT and HbA1c in 167 women with HFDP, 4-12 weeks after delivery. Glucose status was based on American Diabetes Association criteria. Results: Glucose homeostasis was assessed at 10 weeks (IQR 7-12) after delivery. A total of 52/167 (31%) participants had hyperglycemia, 34 (20%) had prediabetes, and 18 (11%) had T2DM. For patients with prediabetes, fasting plasma glucose (FPG) and 2 hour plasma glucose (2hPG) were diagnostic in 12 patients, whereas in two-thirds (22/34) only one time point was diagnostic. FPG and 2hPG values were both in the prediabetes diagnostic range in six women with T2DM. Based on FPG, 15 women with persistent hyperglycemia (11 with prediabetes and four with T2DM) would have been missed (15/52; 29%). The HbA1c accurately classified 85% of the 52 participants with gold standard OGTT defined hyperglycemia and 15 of 18 women with postpartum persistent T2DM. When compared to an OGTT, a single HbA1c of 6.5% (48mmol/mol) postpartum demonstrated a sensitivity of 83% and specificity of 97% for the identification of T2DM. Conclusion: HbA1c may improve access to postpartum testing in overburdened clinical settings where the required standards of OGTT cannot be guaranteed. HbA1c is a valuable test to detect women who will benefit most from early intervention but cannot unequivocally replace OGTT.

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Section: Discussioncontrasting

confidence: 49%

“…The median BMI at booking was 38 kg/m 2 (IQR [33][34][35][36][37][38][39][40][41][42][43][44][45]. Individual BMI's, based on WHO categories (overweight BMI 25.0-29.9 kg/m 2 ; obese BMI ≥ 30kg/m 2) were overweight or obese in all but five study participants [overweight in 20 (12%), obese in 142 (86%)].…”

Section: Antenatal Characteristicsmentioning

confidence: 99%

Early postpartum HbA1c after hyperglycemia first detected in pregnancy - imperfect but not without value

Coetzee

Hall

Vyver

et al. 2023

Preprint

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“…Since the reversal from pre-diabetes to normoglycemia is common in adolescents, especially in those with IFG, A1c is likely to be biomarker more reliable then IFG over time. Indeed, a lower regression to normoglycemia was reported in adults with IA1c compared to the other phenotypes [ 36 ], supporting the hypothesis that this phenomenon may be dependent on a greater stability of IA1c. If this evolution is also confirmed by prospective studies in childhood, the utility of HbA1c monitoring could be crucial in adolescents at high risk of developing diabetes.…”

Section: Discussionmentioning

confidence: 70%

Phenotypes of prediabetes and metabolic risk in Caucasian youths with overweight or obesity

Bonito¹,

Licenziati

Corica

et al. 2022

J Endocrinol Invest

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Purpose To assess the prevalence of pre-diabetes phenotypes, i.e., impaired fasting glucose (IFG), impaired glucose tolerance (IGT), increased HbA1c (IA1c), and their association with metabolic profile and atherogenic lipid profile in youths with overweight/obesity (OW/OB). Methods This cross-sectional study analyzed data of 1549 youths (5–18 years) with OW/OB followed in nine Italian centers between 2016 and 2020. Fasting and post-load measurements of glucose, insulin, and HbA1c were available. Insulin resistance (IR) was estimated by HOMA-IR and insulin sensitivity (IS) by reciprocal of fasting insulin. The atherogenic lipid profile was assessed by triglycerides-to-HDL ratio or cholesterol-to-HDL ratio. Insulinogenic index was available in 939 youths, in whom the disposition index was calculated. Results The prevalence of overall pre-diabetes, IFG, IGT and IA1c was 27.6%, 10.2%, 8% and 16.3%, respectively. Analyzing each isolated phenotype, IGT exhibited two- to three-fold higher odds ratio of family history of diabetes, and worse metabolic and atherogenic lipid profile vs normoglycemic youths; IFG was associated only with IR, while IA1c showed a metabolic and atherogenic lipid profile intermediate between IGT and IFG. Conclusion Prevalence of pre-diabetes was high and IA1c was the most prevalent phenotype in Italian youths with OW/OB. The IGT phenotype showed the worst metabolic and atherogenic lipid profile, followed by IA1c. More studies are needed to assess whether HbA1c may help improving the prediction of diabetes.

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“… 6 In the general population, IGT and IFG have also been shown to be characterized by distinct metabolic characteristics. 30 HbA 1c was not added as a reference criterion for prediabetes because, to our knowledge, HbA 1c 5.7%–6.4% (39–47 mmol/mol) has not been linked to cardiovascular events after transplantation 6 and was only evaluated as an index test, in contrast to IGT and IFG. The diagnostic accuracy of FPG 100–125 mg/dl (5.6–6.9 mmol/L) and HbA 1c 5.7%–6.4% (39–47 mmol/mol) 1 were therefore assessed in the absence of PTDM and compared with the OGTT‐derived diagnosis of IGT and IGT and/or IFG.…”

Section: Methodsmentioning

confidence: 99%

Criteria for prediabetes and posttransplant diabetes mellitus after kidney transplantation: A 2-year diagnostic accuracy study of participants from a randomized controlled trial

Kurnikowski

Nordheim

Schwaiger

et al. 2022

American Journal of Transplantation

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Abbreviations: 2hPG, 2-hour plasma glucose; ADA, American Diabetes Association; AUC, area under the curve; HbA 1c , glycated hemoglobin; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; ITP-NODAT, insulin therapy for the prevention of new onset diabetes after transplantation; KTRs, kidney transplant recipients; OGTT, oral glucose tolerance test; PPV, positive predictive value; PTDM, posttransplant diabetes mellitus; ROC, receiver operating characteristic; STARD, standards for the reporting of diagnostic accuracy studies; WHO, World Health Organization.

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Profiles of Glucose Metabolism in Different Prediabetes Phenotypes, Classified by Fasting Glycemia, 2-Hour OGTT, Glycated Hemoglobin, and 1-Hour OGTT: An IMI DIRECT Study

Abstract: We investigated glucose metabolism in the different prediabetes phenotypes, and found differences in type and degree of impairment for beta-cell function and insulin sensitivity. This may be important for personalized treatment strategies for prevention of type 2 diabetes.

Cited by 21 publications

References 42 publications

Early postpartum HbA1c after hyperglycemia first detected in pregnancy - imperfect but not without value

Early postpartum HbA1c after hyperglycemia first detected in pregnancy - imperfect but not without value

Phenotypes of prediabetes and metabolic risk in Caucasian youths with overweight or obesity

Criteria for prediabetes and posttransplant diabetes mellitus after kidney transplantation: A 2-year diagnostic accuracy study of participants from a randomized controlled trial

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