Evaluating the 1-h post-load glucose level to predict future type 2 diabetes

1-Hour Postload Glucose: Early Screening for High Risk of Type 2 Diabetes in Koreans With Normal Fasting Glucose

CONTEXT

With rising the prevalence of type 2 diabetes mellitus (T2DM) and prediabetes, the importance of 1-hour postload plasma glucose (1-h PG) for early hyperglycemia screening is emphasized.

OBJECTIVE

This study investigates the utility of 1-h PG in predicting T2DM in adults with normal fasting plasma glucose levels.

METHODS

A total of 7504 participants were categorized into 3 groups: normal glucose tolerance (NGT) with 1-h PG < 155 mg/dL, NGT with 1-h PG ≥ 155 mg/dL, and impaired glucose tolerance (IGT). Insulin sensitivity and secretion indices were compared between groups at baseline, and T2DM incidence was analyzed using Cox proportional hazards models. The predictive abilities of 1-h PG and 2-hour postload plasma glucose (2-h PG) were assessed with receiver operating characteristic analysis.

RESULTS

At baseline, the composite insulin sensitivity index in the NGT and 1-h PG ≥ 155 mg/dL group was similarly reduced as in the IGT group (P = .076). Over a mean follow-up of 7.4 years, T2DM developed in 960 patients (12.8%). The highest risk was in the IGT group (hazard ratio, 5.47), followed by the NGT and 1-h PG ≥ 155 mg/dL group (hazard ratio, 2.74), compared to the NGT and 1-h PG < 155 mg/dL group. The 1-h PG level had a higher area under the curve (0.772) than other glycemic parameters, including 2-h PG.

CONCLUSIONS

Even with normal fasting plasma glucose, a 1-h PG ≥ 155 mg/dL indicates lower insulin sensitivity similar to IGT and increased T2DM risk, making it a more effective early screening tool than 2-h PG.

Interaction between sex and one-hour post-load glucose on metabolic syndrome and its components among Chinese people at high risk of diabetes

BACKGROUND

Recently, International Diabetes Federation position statement has adopted one-hour post-load glucose (1hPG) ≥ 8.6 mmol/L for diagnosing intermediate hyperglycemia. We aimed to assess the association of 1hPG ≥ 8.6 mmol/L with metabolic syndrome (MetS) and its components, as well as interaction between sex and 1hPG ≥ 8.6 mmol/L on MetS and its components in Chinese people at high risk of diabetes.

METHODS

The cross-sectional study was conducted in DaQing city of HeiLongJiang Province, China between August, 2023 and January, 2024. Eligible individuals with fasting glucose of 5.6-6.9 mmol/L and age of 25-55 years in health checkup data in the year of 2023 or with at least one risk factor of diabetes were invited to receive the oral glucose tolerance test and biochemical examinations. Individuals with self-reported presence of diabetes or usage of glucose-lowering medication were excluded. MetS was defined as presence of at least three of the five components according to the Chinese Diabetes Society criteria. Logistic regression was performed to evaluate the association of 1hPG ≥ 8.6 mmol/L with MetS and its components. Additive interaction was estimated using the relative excess risk due to interaction, attributable proportion due to interaction (AP), and synergy index.

RESULTS

A total of 2419 subjects comprising 1465 men (60.6%) with a mean age of 45.77 ± 6.20 years were included, and the prevalence of MetS was 46.8%, with 59.7% in men and 27.1% in women. 1hPG ≥ 8.6 mmol/L was associated with MetS (aOR = 4.40, 95% CI 3.26-6.01), elevated blood pressure (aOR = 1.46, 95% CI 1.13-1.89), hyperglycemia (aOR = 15.46, 95% CI 11.56-20.98), and reduced HDL-C (aOR = 1.51, 95% CI 1.07-2.15) in the overall population, whereas no significant association between 1hPG ≥ 8.6 mmol/L and elevated blood pressure in men (aOR = 1.36, 95% CI 0.97-1.91) or dyslipidemia in women (elevated TG: aOR = 0.81, 95% CI 0.47-1.39; reduced HDL-C: aOR = 1.08, 95% CI 0.49-2.37). Additive interaction effect between sex and 1hPG ≥ 8.6 mmol/L on MetS was observed, with 31% attributed to the interaction effect between men and 1hPG ≥ 8.6 mmol/L (AP = 0.31, 95% CI 0.06-0.49).

CONCLUSIONS

There was an additive interaction effect between sex and 1hPG on MetS among Chinese people at high risk of diabetes. 1hPG test and sex-specific strategies should be taken into consideration in cardiometabolic disorder identification and management.

International Diabetes Federation Position Statement on the 1-hour post-load plasma glucose for the diagnosis of intermediate hyperglycaemia and type 2 diabetes

Many individuals with intermediate hyperglycaemia (IH), including impaired fasting glycaemia (IFG) and impaired glucose tolerance (IGT), as presently defined, will progress to type 2 diabetes (T2D). There is confirmatory evidence that T2D can be prevented by lifestyle modification and/or medications, in people with IGT diagnosed by 2-h plasma glucose (PG) during a 75-gram oral glucose tolerance test (OGTT). Over the last 40 years, a wealth of epidemiological data has confirmed the superior value of 1-h plasma glucose (PG) over fasting PG (FPG), glycated haemoglobin (HbA1c) and 2-h PG in populations of different ethnicity, sex and age in predicting diabetes and associated complications including death. Given the relentlessly rising prevalence of diabetes, a more sensitive, practical method is needed to detect people with IH and T2D for early prevention or treatment in the often lengthy trajectory to T2D and its complications. The International Diabetes Federation (IDF) Position Statement reviews findings that the 1-h post-load PG ≥ 155 mg/dL (8.6 mmol/L) in people with normal glucose tolerance (NGT) during an OGTT is highly predictive for detecting progression to T2D, micro- and macrovascular complications, obstructive sleep apnoea, cystic fibrosis-related diabetes mellitus, metabolic dysfunction-associated steatotic liver disease, and mortality in individuals with risk factors. The 1-h PG of 209 mg/dL (11.6 mmol/L) is also diagnostic of T2D. Importantly, the 1-h PG cut points for diagnosing IH and T2D can be detected earlier than the recommended 2-h PG thresholds. Taken together, the 1-h PG provides an opportunity to avoid misclassification of glycaemic status if FPG or HbA1c alone are used. The 1-h PG also allows early detection of high-risk people for intervention to prevent progression to T2D which will benefit the sizeable and growing population of individuals at increased risk of T2D. Using a 1-h OGTT, subsequent to screening with a non-laboratory diabetes risk tool, and intervening early will favourably impact the global diabetes epidemic. Health services should consider developing a policy for screening for IH based on local human and technical resources. People with a 1-h PG ≥ 155 mg/dL (8.6 mmol/L) are considered to have IH and should be prescribed lifestyle intervention and referred to a diabetes prevention program. People with a 1-h PG ≥ 209 mg/dL (11.6 mmol/L) are considered to have T2D and should have a repeat test to confirm the diagnosis of T2D and then referred for further evaluation and treatment. The substantive data presented in the Position Statement provides strong evidence for redefining current diagnostic criteria for IH and T2D by adding the 1-h PG.

Effects of a Novel Blood Glucose Forecasting Feature on Glycemic Management and Logging in Adults With Type 2 Diabetes Using One Drop: Retrospective Cohort Study

Background

Personalized feedback is an effective behavior change technique frequently incorporated into mobile health (mHealth) apps. Innovations in data science create opportunities for leveraging the wealth of user data accumulated by mHealth apps to generate personalized health forecasts. One Drop’s digital program is one of the first to implement blood glucose forecasts for people with type 2 diabetes. The impact of these forecasts on behavior and glycemic management has not been evaluated to date.

Objective

This study sought to evaluate the impact of exposure to blood glucose forecasts on blood glucose logging behavior, average blood glucose, and percentage of glucose points in range.

Methods

This retrospective cohort study examined people with type 2 diabetes who first began using One Drop to record their blood glucose between 2019 and 2021. Cohorts included those who received blood glucose forecasts and those who did not receive forecasts. The cohorts were compared to evaluate the effect of exposure to blood glucose forecasts on logging activity, average glucose, and percentage of glucose readings in range, after controlling for potential confounding factors. Data were analyzed using analysis of covariance (ANCOVA) and regression analyses.

Results

Data from a total of 1411 One Drop users with type 2 diabetes and elevated baseline glucose were analyzed. Participants (60.6% male, 795/1311; mean age 50.2 years, SD 11.8) had diabetes for 7.1 years on average (SD 7.9). After controlling for potential confounding factors, blood glucose forecasts were associated with more frequent blood glucose logging (P=.004), lower average blood glucose (P<.001), and a higher percentage of readings in range (P=.03) after 12 weeks. Blood glucose logging partially mediated the relationship between exposure to forecasts and average glucose.

Conclusions

Individuals who received blood glucose forecasts had significantly lower average glucose, with a greater amount of glucose measurements in a healthy range after 12 weeks compared to those who did not receive forecasts. Glucose logging was identified as a partial mediator of the relationship between forecast exposure and week-12 average glucose, highlighting a potential mechanism through which glucose forecasts exert their effect. When administered as a part of a comprehensive mHealth program, blood glucose forecasts may significantly improve glycemic management among people living with type 2 diabetes.

The mean of fasting, 1-h, and 2-h plasma glucose levels is superior to each separate index in predicting diabetes

AIMS

The fasting, 1-h, and 2-h plasma glucose (PG) levels during oral glucose tolerance test represent different glucose metabolic functions. We examined whether averaging these PG indices (GLU_M0.60.120) results in a better predictor of future type 2 diabetes (T2DM).

METHODS

7533 participants were followed up biannually for 12 years. Hazard ratios (HRs), area under the curve (AUC) of the receiver-operating characteristic, and the net reclassification index (NRI) for T2DM were calculated to compare the discriminative ability of GLU_M0.60.120 versus other PG indices.

RESULTS

The adjusted HRs and 95% confidence intervals for an increase in SD of GLU_M0.60.120 was 2.50 (2.36-2.65) and 1.88 (1.73-2.04) in T2DM-free and normal glucose tolerance (NGT) participants, respectively. The AUC of GLU_M0.60.120 was higher than that of fasting PG, 1-h, and 2-h PG values for T2DM-free (0.79 versus 0.67, 0.77, and 0.73) and NGT (0.73 versus 0.65, 0.72, and 0.61). The model using GLU_M0.60.120 improved the classification of the models with fasting PG, 1-h, and 2-h PG values (NRI: 0.369, 0.272, and 0.282 for T2DM-free and 0.249, 0.131, and 0.351 for NGT participants with all p < 0.001).

CONCLUSIONS

The mean of fasting, 1-h, and 2-h PG levels predicts future T2DM better than each index.