O Chun Kwan, Fan Baoqi, Ho Jane Py, Lau Eric S H, Ko Gary Tc, Lui Juliana Nm, Chow Elaine, Kong Alice Pik Shan, Ma Ronald Ching Wan, Luk Andrea, Chan Juliana C N
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
BMJ Open Diabetes Res Care. 2025 Jun 22;13(3):e004749. doi: 10.1136/bmjdrc-2024-004749.
Family history (FmH) of young-onset type 2 diabetes (YOD) and 1-hour plasma glucose (PG) during the 75-g oral glucose tolerance test predicts incident diabetes, although their interactions remain unknown.
In a workforce cohort established in 1998-2003, we ascertained their glycemic status in 2012-2014. We examined the interaction between FmH-YOD and 1-hour PG in predicting diabetes and used receiver operating characteristics (ROC) analysis to compare the performance of 1-hour PG in participants with or without FmH-YOD.
Among 583 participants (median age (IQR)=41 (36-47) years, 43.7% men, body mass index=23.3 (21.2-26) kg/m, 40.3% (n=235) had FmH-YOD, 1-hour PG=8.1 (6.4-10.1) mmol/L), 99 (17%) had developed diabetes at a follow-up of 12.1 (11.3-13.1) years. In the FmH-YOD group, 45% in the high 1-hour PG group and 17% in the normal 1-hour PG group developed diabetes. The respective figures were 16% and 1.8% in the FmH-NONE group. Both FmH-YOD and 1-hour PG predicted diabetes with a negative interaction between FmH-YOD and 1-hour PG (OR 0.72, 95% CI 0.55 to 0.93, p=0.013). Compared with (FmH-NONE/normal 1-hour PG) group, the ORs of incident diabetes in (FmH-NONE/high 1-hour PG), (FmH-YOD/normal 1-hour PG), (FmH-YOD/high 1-hour PG) groups were 7.4 (95% CI 1.6 to 35.1, p=0.011), 18 (95% CI 3.3 to 98.1, p=0.001) and 28.2 (95% CI 5.5 to 145.9, p<0.001), respectively. In ROC analysis, the C-statistics of 1-hour PG dropped from 0.83 (95% CI 0.76 to 0.90, p<0.001) in the FmH-NONE group to 0.69 (95% CI 0.62 to 0.76, p<0.001) in the FmH-YOD group (difference=0.14 (95% CI 0.04-0.24), p=0.006) where fasting PG (FPG) was the best predictor (0.792 (95% CI 0.730-0.853), p<0.001).
FPG outperformed 1-hour PG in predicting incident diabetes in people with FmH-YOD, calling for precise classification and preventive strategies.
早发型2型糖尿病（YOD）的家族史（FmH）以及75克口服葡萄糖耐量试验期间的1小时血浆葡萄糖（PG）可预测糖尿病发病，但其相互作用尚不清楚。
在1998 - 2003年建立的一个劳动力队列中，我们于2012 - 2014年确定了他们的血糖状态。我们研究了FmH - YOD与1小时PG在预测糖尿病方面的相互作用，并使用受试者工作特征（ROC）分析来比较1小时PG在有或没有FmH - YOD的参与者中的表现。
在583名参与者中（年龄中位数（四分位间距）=41（36 - 47）岁，男性占43.7%，体重指数=23.3（21.2 - 26）kg/m²，40.3%（n = 235）有FmH - YOD，1小时PG = 8.1（6.4 - 10.1）mmol/L），在12.1（11.3 - 13.1）年的随访中有99人（17%）患糖尿病。在FmH - YOD组中，1小时PG高的组中有45%患糖尿病，1小时PG正常组中有17%患糖尿病。在无FmH组中，相应数字分别为16%和1.8%。FmH - YOD和1小时PG均能预测糖尿病，且FmH - YOD与1小时PG之间存在负相互作用（比值比0.72，95%置信区间0.55至0.93，p = 0.013）。与（无FmH/1小时PG正常）组相比，（无FmH/1小时PG高）、（FmH - YOD/1小时PG正常）、（FmH - YOD/1小时PG高）组糖尿病发病的比值比分别为7.4（95%置信区间1.6至35.1，p = 0.011）、18（95%置信区间3.3至98.1，p = 0.001）和28.2（95%置信区间5.5至145.9，p < 0.001）。在ROC分析中，1小时PG的C统计量从无FmH组的0.83（95%置信区间0.76至0.90，p < 0.001）降至FmH - YOD组的0.69（95%置信区间0.62至0.76，p < 0.001）（差异=0.14（95%置信区间0.04 - 至0.24），p = 0.006），其中空腹血糖（FPG）是最佳预测指标（0.792（95%置信区间0.730 - 0.853），p < 0.001）。
在有FmH - YOD的人群中，FPG在预测糖尿病发病方面优于1小时PG，这需要精准的分类和预防策略。
