The 1-h post-load plasma glucose as a novel biomarker for diagnosing dysglycemia

Abstract

Identifying the earliest moment for intervention to avert progression to prediabetes and diabetes in high-risk individuals is a substantial challenge. As β-cell function is already compromised in prediabetes, attention should therefore be focused on identifying high-risk individuals earlier in the so-called pre-prediabetes stage. Biomarkers to monitor progression and identify the time point at which β-cell dysfunction occurs are therefore critically needed. Large-scale population studies have consistently shown that the 1-h plasma glucose (1-h PG) ≥ 155 mg/dl (8.6 mmol/l) during the oral glucose tolerance test detected incident type 2 diabetes and associated complications earlier than fasting plasma glucose or 2-h plasma glucose levels. An elevated 1-h PG level appears to be a better alternative to HbA1c [5.7-6.4% (37-47 mmol/mol)] or traditional glucose criteria for identifying high-risk individuals at a stage when ß-cell function is substantially more intact than in prediabetes. Diagnosing high-risk individuals earlier proffers the opportunity for potentially reducing progression to diabetes, development of microvascular complications and mortality, thereby advancing benefit beyond that which has been demonstrated in global diabetes prevention programs.

Pathophysiological Characteristics Underlying Different Glucose Response Curves: A Latent Class Trajectory Analysis From the Prospective EGIR-RISC Study

“…This method captures change over time in a more intuitive way than the mono-/biphasic classification, and it provides class membership probabilities indicating the certainty of the estimates. Recent studies have focused on the role of 1hPG in the risk of diabetes and diabetes complications (7). Considering our results, however, a cutoff value at 1hPG would not be able to distinguish between classes 3 and 4, just as 2hPG cannot distinguish between classes 2 and 3.…”

“…While 30-min plasma glucose and insulin concentrations are necessary to evaluate first-phase insulin secretion, intermediate time points during an OGTT also have been shown to be useful in predicting diabetes. For instance, 1-h postload plasma glucose (1hPG) concentration has consistently been shown to have a stronger association with incidence of type 2 diabetes than 2hPG, and it has been associated with both cardiovascular disease and mortality (5)(6)(7). Likewise, individuals without diabetes but who have elevated 30-min plasma glucose levels have an increased risk of future diabetes and all-cause mortality, independently of FPG and 2hPG levels (8).…”

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

“…-Subclinical atherosclerosis 65,67 -Subclinical inflammation 69,78 -Vascular stiffness 61,65 -Carotid intima-media thickness 62 Adapted from Jagannathan et al 79 FIGURE 1 Progression of dysglycaemia: novel target for intervention…”

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.…”

“…These findings support the proposal that a 1‐hour PG level ≥ 155 mg/dL (8.6 mmol/L) be adopted into clinical practice to detect earlier progression to worsening dysglycemia and mortality. In addition, shortening the OGTT to 1 hour from a 2‐hour OGTT should facilitate its acceptance in clinical practice 19–21 . Although the 1‐hour OGTT is not formally recognized for screening high‐risk individuals at present, a petition endorsing its use has been submitted to scientific organizations for consideration 23 …”