Department of Pharmaceutical Sciences, Nova Southeastern University, Fort Lauderdale, Florida 33328, USA.
Metab Syndr Relat Disord. 2010 Oct;8(5):395-402. doi: 10.1089/met.2010.0010.
The aim of this study was to determine the prevalence of and the mechanisms by which elevated glucose concentrations at 1-h after a glucose load, conferred increased risk for type 2 diabetes mellitus (T2DM). The study was conducted in subjects with glucose abnormalities (impaired fasting glucose [IFG], and impaired glucose tolerance [IGT]), as well as in normal fasting-normal tolerant subjects (NFG-NGT).
One-hour plasma glucose concentrations were measured as part of 0- to 180-min oral glucose tolerance test (OGTT) performed in an unselected sample of 490 Latino-Hispanics. A cutoff of 154 mg/dL at 1-h during the OGTT was employed, because higher glucose levels define subjects at increased risk for T2DM. Surrogate markers of insulin sensitivity and release, and glucose and insulin time courses were measured. Obesity, cardiovascular risk factors, and presence of metabolic syndrome were also assessed.
One-hour plasma glucose concentrations above the cutoff (≥ 155 mg/dL) were found in 8.3% of NFG-NGT, 43% of IFG, 65% of IGT, and in 90% of IFG + IGT, and were associated with greater postload hyperglycemia (AUCG) and hyperinsulinemia (AUCI), and with reductions in indices of beta-cell function (Delta I 0-30/Delta G 0-30 and Delta I 0-180/Delta G 0-180), insulin sensitivity [Matsuda index, homeostasis model assessment of insulin resistance (HOMA-IR)], and disposition index (Delta 0-30/Delta 0-30 G ÷ HOMA-I), markers of increased risk of T2DM. In addition, those with ≥ 155 mg/dL were older, more obese, had higher blood pressure, and higher prevalence of metabolic syndrome. These clinical and metabolic changes were characteristic of subjects with 1-h plasma glucose concentrations ≥ 155 mg/dL, irrespectively of whether they were classified as NFG-NGT, IFG, or IGT.
One-hour postload plasma glucose levels ≥ 155 mg/dL identified a subgroup of subjects, which by current guidelines are classified as NFG-NGT, IFG, or IGT, but that are at a higher risk that their average group risk. Recognition and management of these subjects may reduce incidence of diabetes and cardiovascular events.
本研究旨在确定在葡萄糖负荷后 1 小时血糖升高的患病率以及导致 2 型糖尿病（T2DM）风险增加的机制。该研究在葡萄糖异常（空腹血糖受损[IFG]和葡萄糖耐量受损[IGT]）患者以及正常空腹-正常耐量（NFG-NGT）患者中进行。
在未选择的 490 名拉丁裔西班牙裔人群中进行了 0 至 180 分钟口服葡萄糖耐量试验（OGTT），作为 OGTT 的一部分，测量了 1 小时血浆葡萄糖浓度。OGTT 中 1 小时的截断值为 154mg/dL，因为较高的血糖水平表明患者有较高的 T2DM 风险。还测量了胰岛素敏感性和释放的替代标志物、血糖和胰岛素时间过程。评估了肥胖、心血管危险因素和代谢综合征的存在。
在 NFG-NGT 中，8.3%的患者在 OGTT 中 1 小时血糖浓度超过截定点（≥155mg/dL），IFG 为 43%，IGT 为 65%，IFG+IGT 为 90%，与餐后高血糖（AUCG）和高胰岛素血症（AUCI）相关，并与β细胞功能指数（Δ I 0-30/Δ G 0-30 和 Δ I 0-180/Δ G 0-180）、胰岛素敏感性[Matsuda 指数、稳态模型评估的胰岛素抵抗（HOMA-IR）]和处置指数（Δ 0-30/Δ 0-30 G ÷ HOMA-I）降低有关，这些都是 T2DM 风险增加的标志物。此外，那些血糖浓度≥155mg/dL 的患者年龄更大、更肥胖、血压更高，且代谢综合征的患病率更高。这些临床和代谢变化是 1 小时血浆葡萄糖浓度≥155mg/dL 的患者的特征，无论他们被归类为 NFG-NGT、IFG 还是 IGT。
1 小时餐后血糖水平≥155mg/dL 可确定一个亚组人群，根据目前的指南，这些人群被归类为 NFG-NGT、IFG 或 IGT，但他们的平均风险更高。识别和管理这些患者可能会降低糖尿病和心血管事件的发生率。
