Zhou Weibin, Gu Yanyun, Li Hong, Luo Min
Department of Endocrinology, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine (SJU-SM, formerly Shanghai Second Medical University), 197, Ruijin 2nd Road, Shanghai 200025, China.
Eur J Endocrinol. 2006 Jul;155(1):191-7. doi: 10.1530/eje.1.02188.
To assess the cutoff values at different time points for impaired glucose regulation (IGR) and diabetes, the glucose curve and isolated 1-h hyperglycemia were monitored during an oral glucose tolerance test (OGTT).
Two thousand eight hundred and eighty-six subjects (1300 men and 1586 women) were recruited to have an OGTT. Plasma was collected at 0, 30, 60, 120, and 180 min to analyze glucose and insulin. The diagnosis of impaired fasting glucose, impaired glucose tolerance, and diabetes was based on World Health Organization and American Diabetes Association's criteria. Those with fasting plasma glucose (FPG) < 5.6 and 2-h plasma glucose (PG) < 7.8, but 1-h PG > or = 7.8 and < 11.1 mmol/l were defined as 1h-High7.8, and those with FPG < 7.0 and 2-h PG < 11.1, but 1-h PG > or =11.1 mmol/l as 1h-High11.1. The cutoff values were calculated by receiver operating characteristic (ROC) curve. The correlation between beta-cell function and the area under the curve of glucose (AUCg) and the shape index was analyzed with linear regression.
The cutoff values for IGR were 5.6, 9.7, 10.1, 7.8 and 6.1 mmol/l for blood glucose at 0, 30, 60, 120 and 180 min, 24 for AUCg and 1.3 mmol/l for the shape index. The cutoff values for diabetes were 6.8, 11.2, 13, 11.1 and 7 mmol/l for 0, 30, 60, 120 and 180 min, 30.9 for AUCg and 2 mmol/l for the shape index. Both AUCg and the shape index were inversely related to beta-cell function. The profiles of glucose and insulin in the subgroup with isolated 1-h hyperglycemia were very different from those seen in subjects with normal glucose tolerance or IGR.
The present study provides new information on measures other than the fasting and 2-h PG to evaluate glucose metabolism in vivo and stimulates further research aimed at assessing the value of the OGTT 1-h PG concentration prospectively.
为评估不同时间点血糖调节受损（IGR）和糖尿病的临界值，在口服葡萄糖耐量试验（OGTT）期间监测血糖曲线及孤立性1小时高血糖情况。
招募2886名受试者（1300名男性和1586名女性）进行OGTT。在0、30、60、120和180分钟采集血浆，分析血糖和胰岛素。空腹血糖受损、糖耐量受损及糖尿病的诊断依据世界卫生组织和美国糖尿病协会的标准。空腹血糖（FPG）<5.6且2小时血浆葡萄糖（PG）<7.8，但1小时PG≥7.8且<11.1 mmol/L的受试者定义为1h - High7.8，FPG<7.0且2小时PG<11.1，但1小时PG≥11.1 mmol/L的受试者定义为1h - High11.1。通过受试者工作特征（ROC）曲线计算临界值。采用线性回归分析β细胞功能与血糖曲线下面积（AUCg）及形状指数之间的相关性。
IGR的临界值为：0、30、60、120和180分钟血糖分别为5.6、9.7、10.1、7.8和6.1 mmol/L，AUCg为24，形状指数为1.3 mmol/L。糖尿病的临界值为：0、30、60、120和180分钟血糖分别为6.8、11.2、13、11.1和7 mmol/L，AUCg为30.9，形状指数为2 mmol/L。AUCg和形状指数均与β细胞功能呈负相关。孤立性1小时高血糖亚组的血糖和胰岛素曲线与糖耐量正常或IGR受试者的曲线差异很大。
本研究提供了除空腹和2小时PG之外用于评估体内葡萄糖代谢的新信息，并推动了旨在前瞻性评估OGTT 1小时PG浓度价值的进一步研究。
