Metabolic profile of normal glucose-tolerant subjects with elevated 1-h plasma glucose values

One-hour post-load glucose is associated with biopsy-proven metabolic dysfunction-associated steatotic liver disease in obese individuals

AIM

To investigate the association between one-hour post-load plasma glucose (1h-PG) levels and metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic-associated steatohepatitis (MASH).

METHODS

Clinical data were collected from 538 obese participants who underwent oral glucose tolerance tests (OGTT) and liver biopsy in the Drum Tower Hospital affiliated with the Nanjing University Medical School. Participants were categorized into normal glucose tolerance (NGT), prediabetes (pre-DM), and type 2 diabetes (T2DM) groups, with further stratification of the NGT group into 1h-PG Low and 1h-PG High. The diagnosis of MASLD and MASH was performed using the NASH Clinical Research Network scoring system. Logistic regression analyses were performed to determine the association between each category and MASLD/ MASH.

RESULTS

The prevalence of MASLD and MASH progressively increased across NGT 1h-PG Low, NGT 1h-PG High, pre-DM and T2DM groups. Compared to the NGT 1h-PG Low group, the NGT 1h-PG High group had a significantly higher risk of MASLD (OR 3.27 [95 % CI 1.32;8.09]) and MASH (OR 3.08 [1.55;6.11]), which is similar to the pre-DM group. Additionally, elevated 1h-PG levels were associated with hepatic steatosis, lobular inflammation, and fibrosis. Mediation analysis indicated that Matsuda insulin sensitivity index and disposition index played a sequential mediating role between 1h-PG and hepatic steatosis, accounting for 14.23 % of total effect (β 0.014 [95 % CI 0.002;0.035]).

CONCLUSION

Elevated 1h-PG levels increase the risk of MASLD and MASH in obese individuals. Early screening and management of MASLD are necessary, even in NGT individuals when 1h-PG levels are ≥8.6 mmol/l.

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.

Expert Group Recommendations on the Effective Use of Bolus Insulin in the Management of Type 2 Diabetes Mellitus

Evidence suggests a major contribution of postprandial glucose (PPG) excursions to the increased risk of micro- and macro-vascular complications in individuals with type 2 diabetes mellitus (T2DM). Administration of bolus insulin remains a very effective therapeutic option for PPG control. The aim of this expert group recommendation document was to provide practical and easy-to-execute guidelines for physicians on the appropriate use of bolus insulin in the management of T2DM. A panel of key opinion leaders from India reviewed and discussed the available clinical evidence and guideline recommendations on the following topics: (1) optimum control of PPG; (2) choice of bolus insulin; and (3) special situations and practical considerations. The expert panel critically analyzed the current literature and clinical practice guidelines and factored their rich clinical experience to develop a set of nine expert group recommendations for the effective use of bolus insulin. These recommendations will not only result in a more evidence-based application of bolus insulin in the clinical setting but also trigger further research and provide a valuable base for the development of future guidelines on the use of bolus insulin in the management of individuals with T2DM.

Elevated one hour with normal fasting and 2 h plasma glucose helps to identify those at risk for development of Type2 Diabetes-11 years observational study from south India

AIMS

To compare conversion rates of diabetes in subjects with elevated 1 h plasma glucose (1hrPG) during an OGTT with normal glucose tolerance(NGT) subjects over a period of 11 years.

METHODS

4023 subjects were selected from electronic data base of medical records.233 subjects who were followed up for a period of 11 years were included.160 with isolated prediabetes and their combinations were excluded.The remaining 73 were categorized into group1 NGT (n = 37) and group-2 (n = 36) with elevated 1hrPG.Kaplan Meier curves for incident diabetes and Cox proportional hazard model were compared between groups.

RESULTS

During follow up, 10.8% and 44.4% converted to DM in group1 and group2 (p = 0.003). Elevated 1hrPG was associated with incident diabetes(HR 7.9[95%CI 2.2-28.1](p = 0.001)provided better risk assessment.The adjusted risk of event in subjects with elevated 1hrPG is likely to be 7 times more when compared to NGT.Subjects with elevated1hrPG remained free of diabetes for a median period of 7.6 years (95% CI 5.8-7.8) whereas NGT subjects remained free for 10 years (95% CI 8.5-10.0) (p < 0.001).

CONCLUSION

In conclusion, conversion to DM was higher and risk was 7 times more in subjects with elevated 1hrPG. Elevated 1hrPG during OGTT has to be considered as a distinct entity.

Cardiometabolic importance of 1-h plasma glucose in obese subjects

Background/objectives

To study the importance and clinical usefulness of the 1-h plasma glucose (1hPG) in a Caucasian obese population with regard to the presence of prediabetes, diabetes, and metabolic syndrome (MetS).

Subjects/methods

We conducted a cross-sectional study of 2439 overweight or obese subjects. All received an oral glucose tolerance test (OGTT) using the American Diabetes Association criteria. ROC-curves were used to compare the sensitivity and (1-specificity) of 1hPG versus FPG and 2hPG to diagnose prediabetes and diabetes.

Results

Of 2439 patients (72.1% female) (age 43 ± 13 years, BMI 37.9 (34.6–41.6) kg/m²), 1262 (51.7%) had a 1hPG ≥ 155 mg/dL. The prevalence of prediabetes was 33.8% and of diabetes 9.8%. In these 240 diabetic patients, only 1.6% (four patients) did not show a 1hPG ≥ 155 mg/dL. Subjects with 1hPG ≥ 155 mg/dL were more insulin resistant (p < 0.001), had a higher waist (p < 0.001), visceral adipose tissue (VAT) (p < 0.001), systolic blood pressure (p < 0.001), microalbuminuria (p < 0.001), PAI-1 (p < 0.001), and worse lipid profile (p < 0.001) than subjects with 1hPG < 155 mg/dL. MetS was present in 64.1% of subjects with 1hPG ≥ 155 mg/dL versus 42.5% of subjects with 1hPG < 155 mg/dL (p < 0.001). In the group with 1hPG ≥ 155 mg/dL 32.6% had a normal glucose tolerance (NGT), 48.9% had prediabetes, and 18.5% was diagnosed with T2DM compared to 81.7% NGT, 17.7% prediabetes, and 0.6% T2DM in subjects with 1hPG < 155 mg/dL (p < 0.001). Among NGT subjects, 30.0% had a 1hPG ≥ 155 mg/dL and showed higher HOMA-IR (p = 0.008), VAT (p < 0.001), blood pressure (p < 0.001), and worse lipid profile (p = 0.001). Compared to 1hPG < 155 mg/dL, the sensitivity and specificity of 1hPG ≥ 155 mg/dL of prediabetes were 74.8% and 60.0% and for diabetes 97.1% and 53.2%, respectively.

Conclusions

This study supports the role of 1hPG value as a valuable tool in the detection of obese subjects at high risk for T2DM and MetS.

The 1h post glucose value best predicts future dysglycemia among normal glucose tolerance subjects

AIM

To analyse the OGTT glycemic parameters - fasting, 1h and 2h plasma glucose values singly and in various combinations; with respect to their prediction of future dysglycemia in subjects with normal glucose tolerance (NGT).

METHODS

Electronic medical records of individuals who underwent an OGTT between 1991 and 2016 at a tertiary diabetes centre were analysed. NGT subjects who had at least one more follow up OGTT (n=1356) were selected for the study. Regarding their prediction of future dysglycemia, the glycemic parameters-Fasting plasma glucose (FPG), 1h plasma glucose (1HrPG) and 2h plasma glucose (2HrPG) were analysed separately and also in different combinations. HbA1c and the combined use of HbA1c and FPG were also compared. Receiver operating characteristic (ROC) curve analysis was performed to assess the capability of various glycemic parameters to discriminate between NGT and dysglycemia. The WHO criteria were used to define dysglycemia as the presence of prediabetes (Impaired fasting glucose and/or Impaired glucose tolerance) or diabetes.

RESULTS

318(23.4%) developed prediabetes (median follow up 3.5years) and 134(10%) developed diabetes (median follow up 5.6years). The 1hrPG had a significantly higher AUC (0.684, 0.716) compared to FPG (0.560 and 0.593) and 2hrPG (0.644 and 0.618) for prediabetes and diabetes respectively. Adding the FPG or the 2hrPG to the 1HrPG did not significantly improve the AUC beyond 1HrPG alone. The 1HrPG also predicted diabetes better than HbA1c as well as the combined use of HbA1c and FPG.

CONCLUSION

The 1HrPG value during OGTT is a good predictor of future dysglycemia among NGT subjects.