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Enhanced predictive capability of a 1-hour oral glucose tolerance test : A prospective population-based cohort study

Pareek, Manan; Bhatt, Deepak L.; Nielsen, Mette L.; Jagannathan, Ram; Eriksson, Karl Fredrik LU ; Nilsson, Peter M. LU ; Bergman, Michael and Olsen, Michael H. (2018) In Diabetes Care 41(1). p.171-177
Abstract

OBJECTIVE To examine whether the 1-h blood glucose measurement would be a more suitable screening tool for assessing the risk of diabetes and its complications than the 2-h measurement. RESEARCH DESIGN AND METHODS We conducted a prospective population-based cohort study of 4,867men, randomly selected fromprespecified birth cohorts between 1921 and 1949,who underwent an oral glucose tolerance test with blood glucose measurements at 0, 1, and 2 h. Subjects were followed for up to 39 years, with registry-based recording of events. Discriminative abilities of elevated 1-h (≥8.6 mmol/L) versus 2-h (≥7.8 mmol/L) glucose for predicting incident type 2 diabetes, vascular complications, andmortality were compared using Kaplan-Meier analysis, Cox... (More)

OBJECTIVE To examine whether the 1-h blood glucose measurement would be a more suitable screening tool for assessing the risk of diabetes and its complications than the 2-h measurement. RESEARCH DESIGN AND METHODS We conducted a prospective population-based cohort study of 4,867men, randomly selected fromprespecified birth cohorts between 1921 and 1949,who underwent an oral glucose tolerance test with blood glucose measurements at 0, 1, and 2 h. Subjects were followed for up to 39 years, with registry-based recording of events. Discriminative abilities of elevated 1-h (≥8.6 mmol/L) versus 2-h (≥7.8 mmol/L) glucose for predicting incident type 2 diabetes, vascular complications, andmortality were compared using Kaplan-Meier analysis, Cox proportional hazards regression, and net reclassification improvement. RESULTS Median agewas 48 years (interquartile range [IQR] 48-49). During follow-up (median 33 years [IQR 24-37]), 636 (13%) developed type 2 diabetes. Elevated 1-h glucose was associatedwith incident diabetes (hazard ratio 3.40 [95% CI 2.90-3.98], P < 0.001) and provided better risk assessment than impaired glucose tolerance (Harrell concordance index 0.637 vs. 0.511, P < 0.001). Addition of a 1-hmeasurement in subjects stratified by fasting glucose provided greater net reclassification improvement than the addition of a 2-h measurement (0.214 vs. 0.016, respectively). Finally, the 1-h glucose was significantly associated with vascular complications and mortality. CONCLUSIONS The 1-h blood glucose level is a stronger predictor of future type 2 diabetes than the 2-h level and is associated with diabetes complications and mortality.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Diabetes Care
volume
41
issue
1
pages
7 pages
publisher
American Diabetes Association
external identifiers
  • scopus:85038961961
ISSN
0149-5992
DOI
10.2337/dc17-1351
language
English
LU publication?
yes
id
c425b721-e539-4e88-8475-dd9c4af51632
date added to LUP
2018-01-22 10:43:29
date last changed
2018-01-23 03:00:15
@article{c425b721-e539-4e88-8475-dd9c4af51632,
  abstract     = {<p>OBJECTIVE To examine whether the 1-h blood glucose measurement would be a more suitable screening tool for assessing the risk of diabetes and its complications than the 2-h measurement. RESEARCH DESIGN AND METHODS We conducted a prospective population-based cohort study of 4,867men, randomly selected fromprespecified birth cohorts between 1921 and 1949,who underwent an oral glucose tolerance test with blood glucose measurements at 0, 1, and 2 h. Subjects were followed for up to 39 years, with registry-based recording of events. Discriminative abilities of elevated 1-h (≥8.6 mmol/L) versus 2-h (≥7.8 mmol/L) glucose for predicting incident type 2 diabetes, vascular complications, andmortality were compared using Kaplan-Meier analysis, Cox proportional hazards regression, and net reclassification improvement. RESULTS Median agewas 48 years (interquartile range [IQR] 48-49). During follow-up (median 33 years [IQR 24-37]), 636 (13%) developed type 2 diabetes. Elevated 1-h glucose was associatedwith incident diabetes (hazard ratio 3.40 [95% CI 2.90-3.98], P &lt; 0.001) and provided better risk assessment than impaired glucose tolerance (Harrell concordance index 0.637 vs. 0.511, P &lt; 0.001). Addition of a 1-hmeasurement in subjects stratified by fasting glucose provided greater net reclassification improvement than the addition of a 2-h measurement (0.214 vs. 0.016, respectively). Finally, the 1-h glucose was significantly associated with vascular complications and mortality. CONCLUSIONS The 1-h blood glucose level is a stronger predictor of future type 2 diabetes than the 2-h level and is associated with diabetes complications and mortality.</p>},
  author       = {Pareek, Manan and Bhatt, Deepak L. and Nielsen, Mette L. and Jagannathan, Ram and Eriksson, Karl Fredrik and Nilsson, Peter M. and Bergman, Michael and Olsen, Michael H.},
  issn         = {0149-5992},
  language     = {eng},
  number       = {1},
  pages        = {171--177},
  publisher    = {American Diabetes Association},
  series       = {Diabetes Care},
  title        = {Enhanced predictive capability of a 1-hour oral glucose tolerance test : A prospective population-based cohort study},
  url          = {http://dx.doi.org/10.2337/dc17-1351},
  volume       = {41},
  year         = {2018},
}