Isfahan Endocrine & metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.
Clin Endocrinol (Oxf). 2017 Dec;87(6):696-705. doi: 10.1111/cen.13443. Epub 2017 Sep 20.
To establish whether the area under the curve of an OGTT has a predictive role in identifying prediabetic and diabetic subjects among first-degree relatives (FDR) of patients with diabetes mellitus type 2 (DM).
DESIGN, PATIENTS AND MEASUREMENTS: In a population-based cohort study, 766 FDR of diabetic patients with a normal glucose tolerance test (NGT) completed a 2-hour OGTT. They were followed up for 7 years and classified according to the American Diabetes Association criteria into: NGT, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and DM. Relative risk (RR) and 95% confidence intervals (95%CI) were calculated based on logistic regression. Receiver operator characteristic (ROC) analysis along with AUC at different intervals and at time points during the OGTT was used to evaluate the risk of prediabetes and diabetes.
Twenty-three subjects (3%) developed type 2 DM, 118 (29.3%) IFG, 81 (11.5%) IGT and 544 (71%) subjects remained NGT. AUC and mean difference of glucose in all high-risk groups demonstrated significant differences in both intervals and time points when compared to the NGT group. The cut-off values during OGTT to predict prediabetes and diabetes was determined as blood glucose more than 7.2 and 7.8 mmol/L at 30 and 60 minutes, respectively. The time point 60 has the highest predictive role for the development of diabetes, alone, and improved the performance of a prediction model containing multiple important clinical risk factors.
The data suggest that the glycaemic response to an OGTT may predict the risk of development of diabetes in first-degree relatives of DM patients.
评估口服葡萄糖耐量试验（OGTT）曲线下面积（AUC）在识别 2 型糖尿病（DM）患者一级亲属（FDR）中糖尿病前期和糖尿病患者是否具有预测作用。
设计、患者及测量方法：在一项基于人群的队列研究中，766 例糖耐量正常（NGT）的糖尿病 FDR 完成了 2 小时 OGTT。对他们进行了 7 年的随访，并根据美国糖尿病协会（ADA）标准分为：NGT、空腹血糖受损（IFG）、糖耐量受损（IGT）和 DM。基于逻辑回归计算相对风险（RR）和 95%置信区间（95%CI）。通过接受者操作特征（ROC）分析以及 AUC 在不同时间点和 OGTT 期间的不同时间点，评估糖尿病前期和糖尿病的风险。
23 例（3%）患者发展为 2 型糖尿病，118 例（29.3%）IFG、81 例（11.5%）IGT 和 544 例（71%）患者仍为 NGT。与 NGT 组相比，所有高危组的 AUC 和葡萄糖平均值在两个时间点和两个时间间隔均存在显著差异。OGTT 中预测糖尿病前期和糖尿病的截断值为 30 分钟时血糖>7.2mmol/L 和 60 分钟时血糖>7.8mmol/L。60 分钟这个时间点对糖尿病的发生具有最高的预测作用，单独使用时，它可以改善包含多个重要临床危险因素的预测模型的性能。
数据表明，OGTT 的血糖反应可能预测 DM 患者一级亲属发生糖尿病的风险。
