Reducing the prevalence of dysglycemia: is the time ripe to test the effectiveness of intervention in high-risk individuals with elevated 1 h post-load glucose levels?

Abstract

Identifying the earliest time point on the prediabetic continuum is critical to avoid progressive deterioration in β-cell function. Progressively rising glucose levels even within the "normal range" occur considerably late in the evolution to diabetes thus presenting an important opportunity for earlier diagnosis, treatment, and possible reversal. An elevated 1 h postprandial glucose level, not detected by current diagnostic standards, may provide an opportunity for the early identification of those at risk. When the 1 h post-load glucose level is elevated, lifestyle intervention may have the greatest benefit for preserving β-cell function and prevent further progression to prediabetes and diabetes. In view of the considerable consistent epidemiologic data in large disparate populations supporting the predictive capacity of the1 h post-load value for predicting progression to diabetes and mortality, the time is therefore ripe to evaluate this hypothesis in a large, prospective multicenter randomized trial with lifestyle intervention.

Novel biomarkers for prediabetes, diabetes, and associated complications

“…However, intermediate time points during the OGTT (e.g., 30 or 60 minute post-load values) appear to predict progression to T2DM better than fasting, 2-hour post-load glucose or HbA1c levels, making this approach more favorable with the possibility of shortening the traditional 2-hour test. 152 Additional studies are required to identify the most accurate biomarker(s), recognizing that a single determinant will likely have inherent limitations. Therefore, combining several biomarkers may more precisely predict those at high risk for developing prediabetes and subsequent progression to diabetes.…”

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

“…[17][18][19][20][21][22][23] Warren et al recently compared these tests and threshold levels for identifying prediabetes 24 extending previous observations demonstrating different and overlapping prevalence of prediabetes according to the definition used. [24][25][26][27] 1.2 | Pathophysiologic studies 1.2.1 | β-cell dysfunction as a continuous process Glucose intolerance and insulin resistance worsen over time leading to a continuous decline in β-cell dysfunction that increases the likelihood of developing type 2 diabetes. Individuals with "normal" FPG levels approximating 94 mg/dl (5.2 mmol/L), ie, falling below the IFG threshold (100 mg/dl [5.6 mmol/L]), remain at an increased risk for developing diabetes.…”

“…The definition of prediabetes is controversial given 5 different fasting glucose and HbA 1c criteria with differing sensitivities and specificities (Table ) resulting in differing prevalence and clinical outcomes . Warren et al recently compared these tests and threshold levels for identifying prediabetes extending previous observations demonstrating different and overlapping prevalence of prediabetes according to the definition used …”

Use of 1‐h post‐load plasma glucose concentration to identify individuals at high risk of developing Type 2 diabetes

“…Identifying high-risk individuals using the 1-h PG is an important and novel strategy to potentially avert the development of Type 2 diabetes. If confirmed by future studies, the 1-h PG concentration could eventually replace conventional glycaemic measurements making it more acceptable in clinical practice [17].…”