Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.
Catholic University, Rome, Italy.
Atherosclerosis. 2016 Oct;253:61-69. doi: 10.1016/j.atherosclerosis.2016.08.020. Epub 2016 Aug 25.
Evidence suggests that combining 1-hour plasma glucose ≥155 mg/dl during an oral glucose tolerance test (OGTT) with glycosylated hemoglobin (HbA1c) significantly increases their predictive power for incident diabetes, while their individual and joint associations with cardio-metabolic risk factors remain undefined. Herein, we evaluated whether 1-hour post-load plasma glucose ≥155 mg/dl combined with HbA1c may identify pre-diabetic individuals with a higher cardio-metabolic risk.
Anthropometric and metabolic characteristics, insulin sensitivity and insulin secretion assessed by OGTT-derived indexes, carotid intima-media thickness (IMT), pulse pressure, and rate pressure product were evaluated in 1495 individuals.
As compared with subjects with 1-hour post-load glucose <155 mg/dl, individuals with 1-hour post-load glucose ≥155 mg/dl exhibited a significantly worse cardio metabolic profile, both in the group with HbA1c <5.7%, and in the group with prediabetes (HbA1c 5.7-6.4%). Specifically, in both groups, subjects with 1-hour post-load glucose ≥155 mg/dl had higher fasting and 2-h post-load glucose (p < 0.0001 for all in both groups), higher HOMA-IR (p < 0.0001 in both groups), and carotid IMT (p = 0.05 in the group with HbA1c <5.7% and p = 0.03 in the group HbA1c 5.7-6.4%), as well as lower Matsuda index, insulinogenic index and disposition index (p < 0.0001 in both groups), and lower insulin-stimulated glucose disposal (p < 0.0001 in the group with HbA1c <5.7% and p = 0.03 in the group HbA1c 5.7-6.4%).
Hyperglycemia at 1-hour during an OGTT may be a useful tool to identify a subset of individuals within HbA1c-defined glycemic categories at higher risk of developing type 2 diabetes and cardiovascular disease.
有证据表明，将口服葡萄糖耐量试验（OGTT）期间 1 小时血浆葡萄糖≥155mg/dl 与糖化血红蛋白（HbA1c）相结合，可显著提高其对新发糖尿病的预测能力，而其与心血管代谢危险因素的单独和联合关联仍不明确。在此，我们评估了 1 小时负荷后血糖≥155mg/dl 联合 HbA1c 是否可识别出具有更高心血管代谢风险的糖尿病前期个体。
在 1495 名个体中评估了人体测量和代谢特征、OGTT 衍生指数评估的胰岛素敏感性和胰岛素分泌、颈动脉内膜中层厚度（IMT）、脉压和速率压力产物。
与 1 小时负荷后血糖<155mg/dl 的个体相比，1 小时负荷后血糖≥155mg/dl 的个体表现出更差的心血管代谢特征，在 HbA1c<5.7%的组和糖尿病前期（HbA1c 5.7-6.4%）的组中均如此。具体而言，在两组中，1 小时负荷后血糖≥155mg/dl 的个体空腹和 2 小时负荷后血糖更高（两组均 p<0.0001）、HOMA-IR 更高（两组均 p<0.0001）、颈动脉 IMT 更高（HbA1c<5.7%组 p=0.05，HbA1c 5.7-6.4%组 p=0.03），以及 Matsuda 指数、胰岛素原指数和处置指数更低（两组均 p<0.0001）和胰岛素刺激的葡萄糖处置率更低（HbA1c<5.7%组 p<0.0001，HbA1c 5.7-6.4%组 p=0.03）。
OGTT 期间 1 小时的高血糖可能是一种有用的工具，可识别 HbA1c 定义的血糖类别中处于更高发生 2 型糖尿病和心血管疾病风险的亚组个体。
