1 h OGTT. Nya vindar för diagnostik av T2DM & prediabetes

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International Diabetes Federation releases Position Statement recommending use of 1 hour post-load plasma glucose to diagnose intermediate hyoerglycemia and type 2 diabetes
 
• as a more sensitive and practical method 
8,6 for intermeduate hyperglycemia/prediabetes resp 11,6 mmol/l for T2DM
 
to screen for diabeets in people at risk.
 

The International Diabetes Federation (IDF) has released a Position Statement that presents the 1-hour post-load plasma glucose (1-h PG) test as a more sensitive and practical method to screen for intermediate hyperglycaemia (IH) and type 2 diabetes(T2D) in people at risk.

The Statement was prepared by an international panel* of 22 experts from 15 countries and presented at the 17th International Conference on Advanced Technologies & Treatments for Diabetes (ATTD)in Florence, Italy and was published online in Diabetes Research and Clinical Practice.

https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(24)00073-1/abstract

• The Statement recommends the use of 1-h PG with the validated cut points of 8.6 mmol/L for IH and 11.6 mmol/L for T2D.

IH, sometimes referred to as “prediabetes,” is a state between normal glucose regulation (NGR) and T2D. It includes impaired fasting glycaemia (IFG) and impaired glucose tolerance (IGT).

Many individuals with IH as defined by current diagnostic criteria, will progress to T2D. Evidence shows that T2D can be prevented by lifestyle modification and/or medications in people with IGT diagnosed by 2-h PG during a 75-gram oral glucose tolerance test (OGTT).

• Unfortunately, many people with T2D and those with IGT remain undiagnosed if an OGTT is not employed. Given the continued rising prevalence of diabetes worldwide, a more sensitive and practical method is therefore needed to detect people with IH and T2D for early diagnosis and intervention.

A wealth of epidemiological data has confirmed the superior value of 1-h PG over fasting PG (FPG), glycated haemoglobin (HbA1c) and 2-h PG in populations of different ethnicity, sex and age.

The IDF Position Statement reviews findings that the 1-h post-load PG > 155 mg/dL (8.6 mmol/L) in those with NGR during an OGTT is highly predictive for detecting people at risk of progression to T2D, micro- and macrovascular complications, obstructive sleep apnoea, cystic fibrosis-related diabetes, metabolic dysfunction-associated steatotic liver disease, and premature death. Importantly, by using the 1-h PG cut points of 155 mg/dL (8.6 mmol/L) for diagnosing IH and 209 mg/dL (11.6 mmol/L) for diagnosing T2D, people at risk can be detected earlier than with the currently recommended glycaemic thresholds.

• Therefore, the IDF Position Statement recommends the adoption of 1-h PG with the aforementioned cut points.

Presenting the Position Statement at ATTD, Professor Michael Bergman, who co-chaired the Expert Panel with Professor Jaakko Tuomilehto, said,

“There are many people who would not be diagnosed through an HbA1c or FPG test but who would, if given an OGTT, be more likely to be detected as having IH or T2D. The 1-h PG has been found to be a more sensitive biomarker for the earlier identification of these high-risk individuals.”

The IDF Position Statement proposes the following pathway for detecting IH and T2D:

  • People determined to be at high-risk for T2D through a validated screening tool (e.g. Finnish FINDRISC, ADA risk score) should undergo a 75-gram 1-h OGTT after an overnight fast.
  • People with a 1-h PG value at or above 155 mg/dL (8.6 mmol/L) are considered to have IH and should be prescribed lifestyle intervention and referred to a diabetes prevention programme.
  • People with a 1-h PG value at or above 209 mg/dL (11.6 mmol/L) are considered to have T2D. They should have a repeat test to confirm the diagnosis and then be referred for further evaluation and treatment.

Commenting on the Position Statement, Professor Akhtar Hussain, President of the International Diabetes Federation, said,

“The latest IDF estimates suggest that a staggering 850 million adults worldwide are affected by intermediate glycaemia. Its early detection is key to preventing or delaying the progression to diabetes and avoiding the serious and often life-threatening complications associated with the condition.

- I congratulate the Expert Panel for the work undertaken to develop this IDF Position Statement. We welcome further discussion on the use of this method to detect IH and type 2 diabetes.”

Although there are challenges inherent in implementing the 1-h OGTT, using this test after screening with a non-laboratory diabetes risk tool will help identify people at high risk of T2D earlier and contribute to reducing the global impact of diabetes, advancing global public health beyond the significant achievements in diabetes prevention studies.

Access the statement here.

The expert panel was co-chaired by Professor Michael Bergman, Professor of Medicine and Population Health at New York University Grossman School of Medicine, New York City and Professor Jaakko Tuomilehto, Professor Emeritus of Public Health, University of Helsinki, Finland, and Visiting Scientist, Finnish Institute for Health and Welfare, Helsinki, Finland. Leadership and support for this initiative were provided by Professor Akhtar Hussain, President of the International Diabetes Federation, Professor (Diabetes & Metabolic Disorder) NORD University, Bodø, Norway and Professor Antonio Ceriello IRCCS MultiMedica, Milan, Italy.

Presss release IDF

 

Nyhetsinfo

www red DiabetologNytt

_________________

https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(24)00073-1/abstract

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

Published:March 06, 2024DOI:https://doi.org/10.1016/j.diabres.2024.111589

Abstract

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 HbA1calone 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.

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    Elevated 1-h post-load plasma glucose levels in normal glucose tolerance children with obesity is associated with early carotid atherosclerosis.Obes Res Clin Pract.2020; 14([As compared with NGT individuals with a 1-h PG <155mg/dL, NGT individuals with a 1-h PG ≥155mg/dL exhibited higher carotid IMT (0.75±0.15mm vs. 0.68±0.15mm; p<0.05). No significant differences were observed in carotid IMT between IGT and NGT subjects with a 1-h PG ≥155mg/dL (0.75±0.18mm vs 0.75±0.15mm; p>0.05). Of the three glycemic parameters, 1-h and 2-h PG, but not fasting glucose, were significantly correlated with carotid IMT. There were no significant differences for increased risk of having NAFLD between the three groups. These data suggest that a value of 1-h PG ≥155mg/dL in children and adolescents with obesity is as important as IGT with respect to cardiovascular risk]): 136-141View in Article
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    Oral glucose tolerance test in patients with cystic fibrosis compared to the overweight and obese: a different approach in understanding the results.Children.2022; 9([Late peak glucose and 1 h glucose level ≥ 155 mg/dL during OGTT can be used for diagnosing the early glucose metabolism alteration in children with CF]): 533View in Article
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    One-hour versus two-hour postprandial blood glucose measurement in women with gestational diabetes mellitus: which is more predictive?.Endocrine.2016; 52([Postprandial 1-h and postprandial 2-h plasma glucose measurements were not superior to each other in predicting fetal macrosomia or perinatal complications. Based on our findings, it can be concluded that both methods may be suitable for follow-up as there are no clear advantages of one measurement over the other]): 561-570View in Article
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    • Tung J.Y.-L. 
    Thirty-minute post-load glucose could be a useful screening measure for abnormal oral glucose tolerance test response in adolescents with obesity.J Obes Metab Syndr.2022; 31([Addition of 30-minute PG to non-fasting parameters improved the clinical utility in identifying high-risk individuals for abnormal OGTT response]): 272-276View in Article
    • Popovic D.S. 
    • Papanas N. 
    1 h post-load plasma glucose: Should it be re-examined as a diagnostic criterion of diabetes?.Prim Care Diabetes.2021; 15([According to the current American Diabetes Association guidelines, diagnosis of both prediabetes and diabetes in asymptomatic individuals is based on the measurements of fasting plasma glucose (FPG), 2-h plasma glucose (2-h PG) during a 75-g oral glucose tolerance test (OGTT), and glycated haemoglobin (HbA1c) [1]. Pre-diabetes is intermediate glucose metabolism abnormality, encompassing impaired fasting glucose (IFG), impaired glucose tolerance, and borderline HbA1c. Moreover, 1-h plasma glucose (1-h PG) during OGTT is used exclusively for diagnosing gestational diabetes. Forty years ago, 1-h PG was abandoned as diagnostic criterion for dysglycemia, primarily due to fact that it has been proven as a less sensitive and specific indicator of diabetes presence in comparison to 2-h PG. However, at that time, the election between these two criteria was not based on their ability to predict the risk of diabetic complications, which was scrutinised in the study demonstrating that 1-h PG is equally useful to 2-h PG in the prediction of retinopathy risk. Nevertheless, accumulating evidence indicates that 1-h PG ≥ 8.6 mmol/l in individuals with normal glucose tolerance (NGT) is highly predictive of progression to type 2 diabetes, microvascular and macrovascular complications, and mortality. Hence, a group of experts have united in advocating replacement of current OGTT criteria for pre-diabetes. The repercussion of this initiative is more frequent sampling of 1-h PG during the assessment of glucose tolerance. However, this trend raises one important practical question: How shall we correctly interpret the significantly elevated 1-h PG (e.g. ≥11.1 mmol/l) in individuals not diagnosed with diabetes, especially among those classified as having prediabetes defined by the presence of IFG and/or borderline HbA1c, or among those characterised as having NGT?. Available data on the potential specific cut-off value of 1-h PG for diagnosing diabetes is sparse. The aforementioned study has reported that 1-h PG ≥ 12.8 mmol/l may be a threshold for diabetes diagnosis, given that it has almost identical sensitivity and specificity for retinopathy as 2-h PG ≥ 11.1 mmol/l. Furthermore, in the EUROASPIRE IV trial including coronary artery disease patients without previous history of diabetes, the cut-off value of 1 h-PG ≥12.0 mmol/l has demonstrated balanced sensitivity and specificity for detecting diabetes. Obviously, future studies re-examining the utility of 1-h PG in the timely diagnosis of diabetes, potentially contributing to the reduction of chronic complications, are highly desirable]): 622View in Article
    • Sasaki N. 
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    • Nakano Y. 
    • Higashi Y. 
    Diversity in the risk of type 2 diabetes associated with age, sex, and 1-h post-load plasma glucose levels in the Japanese population with prediabetes.Diabetes Res Clin Pract.2021; 175([The assessment of age and sex-differences and subdivided prediabetes categories based on FPG and 1-h post-load glucose levels may effectively evaluate the risk of type 2 diabetes, which displays marked diversity])108780View in Article
    • Wang R. 
    • Liu X.L. 
    • Jia X.J. 
    • Liu Y. 
    • Lu Q. 
    one-hour post-load plasma glucose levels are associated with early arterial stiffness in subjects with different glucose tolerance.Diabetes Metab Syndr Obes.2022; 15([The present study demonstrated the presence of early arterial stiffness in diabetes. Elevated 1-hour post-load plasma glucose level is closely related to the change of arterial elasticity in diabetes]): 1537-1542View in Article
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    Early maternal circulating alkaline phosphatase with subsequent gestational diabetes mellitus and glucose regulation: a prospective cohort study in China.Endocrine.2019; 65([Each additional 10 U/L ALP level was associated with a 2% higher FBG (p = 0.043) and a 12% higher 1-h PBG (p = 0.004)]): 295-303View in Article
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