Examination of the fasting and 2-h plasma glucose in the light of impairment in beta-cell function: what does the epidem
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ORIGINAL ARTICLE
Examination of the fasting and 2-h plasma glucose in the light of impairment in beta-cell function: what does the epidemiological data tell us? Suhail A. R. Doi • Glenn M. Ward
Received: 10 January 2014 / Accepted: 2 May 2014 Ó Springer Science+Business Media New York 2014
Abstract We re-assess the fasting plasma glucose (FPG) and 2-h post-load glucose (2HPG) in the diagnosis of both prediabetes and type 2 diabetes mellitus by developing a gold standard based on beta-cell function. The gold standard was developed in a cohort of 2,152 adult subjects without severe renal or liver dysfunction that also had a 2-h oral glucose tolerance test (OGTT) during the Third National Health and Nutrition Examination Survey. Betacell function was computed based on a composite of insulin secretion (determined based on the insulin and glucose responses to the OGTT) and the homeostasis model insulin resistance index. The X-tile program was used to generate the most appropriate categories of minor, moderate and severe impairment of beta-cell function based on the best
Electronic supplementary material The online version of this article (doi:10.1007/s12020-014-0284-0) contains supplementary material, which is available to authorized users.
discrimination of ln(insulin secretion). Subjects with a moderate or severe impairment in beta-cell function were used to define prediabetes and diabetes, respectively, and was the standard against which the FPG and 2HPG were evaluated. It is shown that the current definitions of diabetes by the FPG and 2HPG mirror those derived using impairment of beta-cell function as the gold standard. It is also shown that lowering the cutoff for the FPG does little to improve its use in the screening for prediabetes. A major finding is that the current 2HPG cutoff is inadequate and thus in need of revision to [6.7 mmol/L ([120 mg/dL) from 7.8 mmol/L (140 mg/dL) for the lower cutoff. The use of a model of beta-cell function and impairment of insulin secretion has thus put the utility of the FPG and 2HPG into perspective: We recommend that performing an OGTT be considered pivotal for accurate identification of subjects with impaired beta-cell function (and thus prediabetes) and a revision of the OGTT lower cutoff be considered based on the results of this study.
S. A. R. Doi (&) Clinical Epidemiology Unit, School of Population Health, University of Queensland, Brisbane, Herston Road, Herston, QLD 4006, Australia e-mail: [email protected]; [email protected]
Keywords Oral glucose tolerance Prediabetes Impaired fasting glucose Impaired glucose tolerance Insulin resistance Insulin secretion HOMA-IR
S. A. R. Doi Department of Endocrinology and Diabetes, Goulburn Valley Health, Shepparton, VIC, Australia
Introduction
G. M. Ward Department of Endocrinology and Diabetes, St Vincents Hospital, Melbourne, VIC, Australia G. M. Ward Department of Clinical Biochemistry, St Vincents Hospital, Melbourne, VIC, Australia G. M. Ward University of Melbourne, Melbourne, VIC, Australia
Type 2 dia
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