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Guide: Get the OGTT test sheet, in addition to fasting and 2h blood glucose, we often see the 1/2h, 1h and 3h blood glucose values.
Among them, 2h blood glucose is closely related to the occurrence of complications such as diabetic retinopathy, and has a clear position in the diagnosis of diabetes.
Regarding OGTT (1h-PG), we have not paid much attention in the past, and the guideline mentions less.
The main application may be to evaluate the function of pancreatic islet cells in patients with the C-peptide release test.
However, more and more evidence shows that the diagnostic significance of OGTT (1h-PG) may be underestimated by us.
Recently, a meta-analysis study published in the high-scoring journal Diabetes care showed that OGTT (1h-PG) 11.
6mmol/L as a diagnostic cut-off point of T2DM has high sensitivity and specificity.
For this index, we have Further understanding.
T2DM diagnostic criteria have undergone two major adjustments.
In 1979, the National Diabetes Data Group (NDDG) and the World Health Organization (WHO) established a basic method for T2DM diagnosis-based on fasting blood glucose levels or 75 g oral glucose tolerance test (OGTT) T2DM is diagnosed by blood glucose level 2 hours later.
After that, the WHO and the American Diabetes Association (ADA) made two major adjustments to the diagnostic criteria: 1.
The diagnostic criteria for reducing diabetic fasting blood glucose (FPG): reduced from 7.
8mmol/L to 7.
0mmol/L (in the late 1990s) ); 2.
Introduce HbA1c as the diagnostic criteria for diabetes (around 2010).So far, fasting blood glucose, random blood glucose, OGTT (2h-PG) blood glucose, and HbA1c have been used as the main basis for the diagnosis of diabetes.
Because OGTT (1h-PG) and OGTT (2h-PG) are highly similar, WHO and ADA have rejected them one after another.
The former, but more research has been published in recent years.
Why is the diagnostic significance of OGTT (1h-PG) underestimated? OGTT is considered to be the "gold standard" for diagnosing diabetes.
Although its coefficient of variation is large and it is not convenient to operate, it is important to reflect the progressive failure of the patient's β-cell function (the main manifestation that drives the development of overt diabetes).
Although OGTT is usually only applied to FPG and 2h-PG levels in clinical practice, the deterioration of its own insulin secretion status can be comprehensively estimated by glucose and insulin concentration.
Compared with OGTT (2h-PG), OGTT (1h-PG) has a stronger correlation with the patient's systemic insulin sensitivity index (Matsuda index), the 120-minute glucose disposal index, and the area under the glucose curve.
Considering that in patients who progress to T2DM, these alternative measures of insulin secretion and insulin sensitivity are always low and difficult to evaluate.
Therefore, OGTT (1h-PG) can also predict the progression of T2DM more accurately than IFG, IGT and HbA1c.
The current diagnostic threshold for diabetes is based on the correlation between blood glucose levels and diabetic retinopathy, especially non-proliferative diabetic retinopathy.
Previous studies have shown that OGTT (1h-PG) is significantly related to the incidence and incidence of diabetic retinopathy in American Indians, and is also significantly related to the incidence of diabetic retinopathy in the Swedish population.
A number of studies have shown that OGTT (1h-PG) is related to cardiovascular prognosis and mortality.
In addition, in the Malmö prevention project, OGTT (1h-PG) is more predictive of cardiovascular death and all-cause mortality than OGTT (2h-PG) in non-diabetic male subjects.
Studies on people of different races have shown that OGTT (1h-PG) blood glucose ≥8.
6mmol/L is a more accurate predictor of T2DM than IFG, IGT, HbA1c or the combination.
Therefore, an expert group has proposed that OGTT (1h-PG) blood glucose ≥ 8.
6mmol/level to define pre-diabetes.
In addition, some studies have found that OGTT (1h-PG) is more closely related to insulin secretion, and it can shorten the detection time.
Several other studies have shown that compared with FPG and HbA1c, OGTT (1h-PG) blood glucose has a better and more independent association with cardiovascular disease and all-cause death.
In this study, researchers evaluated the potential of OGTT (1h-PG) for the diagnosis of T2DM.
Research Overview This meta-analysis included a total of 15 related studies (n=35,551), aiming to explore the OGTT (1h-PG) blood glucose cut-off point for the diagnosis of T2DM, and included multi-ethnic populations, including white people and American Indians.
People, Japanese, Mexican American and South Asian population (non-white accounted for 46.
2%).
The researchers used OGTT (2h-PG) blood glucose as a standard of 11.
1mmol/L, and non-diabetic people [OGTT (2h-PG) blood glucose <11.
1mmol/L] as a control group to compare and analyze OGTT (1h-PG) blood glucose .
In order to determine the optimal OGTT (1h-PG) blood glucose cut-off point, in the random effects model, the researchers selected the λ value that is the best combination of specificity and sensitivity.
OGTT (1h-PG) 11.
6 mmol/L may be used as a diagnostic cut point for diabetes, with high sensitivity and specificity.
The results of this meta-analysis show: OGTT (1h-PG) blood glucose 11.
6 mmol/L is used as the diagnostic cut point for T2DM In comparison, OGTT (2h-PG) has good sensitivity (92%) and specificity (91%). The cut-off value has a sensitivity of 92% and a specificity of 91%.
What does it mean? The criterion for judging whether the cut point is effective is whether it can distinguish disease individuals with high accuracy, that is, how sensitive and specific the cut point is.
➤Sensitivity: refers to the percentage of "true positive" in the positive laboratory test results.
The closer the sensitivity is to 100%, the more "true positive" patients can be detected at the cut point; ➤Specificity: refers to the negative test results The percentage of "true negative" in the test results, the closer the specificity is to 100%, the more the cut point can exclude the "false negative" people who are not sick.
Specifically: ➤ Sensitivity 92%: Taking OGTT (1-h PG) 11.
6mmol/L as the cut point, 2489 cases (92%) of 2705 T2DM patients can be detected, but 216 cases (8%) were missed; ➤Specificity 91%: Taking OGTT (1-h PG) 11.
6mmol/L as the cut point can correctly classify 31,164 (91%) of the 32,246 non-diabetic people as non-diabetic patients, but 3082 people (9 %) Wrongly classified as diabetic patients, that is, the false positive rate is higher.
Adopt standardized diagnostic procedures, or reduce the proportion of false positives.
Researchers pointed out that it is not recommended to use OGTT for T2DM (or pre-diabetes) screening because of low feasibility and economic considerations.
Advocate the use of validated diabetes risk screening scores (such as the Finnish diabetes risk score) to identify high-risk groups, and further OGTT laboratory testing for high-risk groups may help reduce the proportion of false positives.
Summary of this article To sum up, this meta-analysis shows that: OGTT (1h-PG) 11.
6mmol/L or can be used as a diagnostic cut-off point for T2DM, compared with OGTT (2h-PG) ≥ 11.
1mmol/L has high sensitivity And specificity.
In order to improve the reliability of this indicator, further research is needed in the following areas: first, it is recommended to conduct more reproducible studies to verify the results; second, it is recommended to conduct a population-based longitudinal study to compare 1h-PG And 2h-PG and diabetic retinopathy and other microvascular complications, cardiovascular complications and all-cause mortality.
References: [1] Vasudha Ahuja, Pasi Aronen, TA Pramodkumar, et al.
Accuracy of 1-Hour Plasma Glucose During the Oral Glucose Tolerance Test in Diagnosis of Type 2 Diabetes in Adults: A Meta-analysis Diabetes Care.
2021; 44 :1062–1069.
https://doi.
org/10.
2337/dc20-1688.
Guide: Get the OGTT test sheet, in addition to fasting and 2h blood glucose, we often see the 1/2h, 1h and 3h blood glucose values.
Among them, 2h blood glucose is closely related to the occurrence of complications such as diabetic retinopathy, and has a clear position in the diagnosis of diabetes.
Regarding OGTT (1h-PG), we have not paid much attention in the past, and the guideline mentions less.
The main application may be to evaluate the function of pancreatic islet cells in patients with the C-peptide release test.
However, more and more evidence shows that the diagnostic significance of OGTT (1h-PG) may be underestimated by us.
Recently, a meta-analysis study published in the high-scoring journal Diabetes care showed that OGTT (1h-PG) 11.
6mmol/L as a diagnostic cut-off point of T2DM has high sensitivity and specificity.
For this index, we have Further understanding.
T2DM diagnostic criteria have undergone two major adjustments.
In 1979, the National Diabetes Data Group (NDDG) and the World Health Organization (WHO) established a basic method for T2DM diagnosis-based on fasting blood glucose levels or 75 g oral glucose tolerance test (OGTT) T2DM is diagnosed by blood glucose level 2 hours later.
After that, the WHO and the American Diabetes Association (ADA) made two major adjustments to the diagnostic criteria: 1.
The diagnostic criteria for reducing diabetic fasting blood glucose (FPG): reduced from 7.
8mmol/L to 7.
0mmol/L (in the late 1990s) ); 2.
Introduce HbA1c as the diagnostic criteria for diabetes (around 2010).So far, fasting blood glucose, random blood glucose, OGTT (2h-PG) blood glucose, and HbA1c have been used as the main basis for the diagnosis of diabetes.
Because OGTT (1h-PG) and OGTT (2h-PG) are highly similar, WHO and ADA have rejected them one after another.
The former, but more research has been published in recent years.
Why is the diagnostic significance of OGTT (1h-PG) underestimated? OGTT is considered to be the "gold standard" for diagnosing diabetes.
Although its coefficient of variation is large and it is not convenient to operate, it is important to reflect the progressive failure of the patient's β-cell function (the main manifestation that drives the development of overt diabetes).
Although OGTT is usually only applied to FPG and 2h-PG levels in clinical practice, the deterioration of its own insulin secretion status can be comprehensively estimated by glucose and insulin concentration.
Compared with OGTT (2h-PG), OGTT (1h-PG) has a stronger correlation with the patient's systemic insulin sensitivity index (Matsuda index), the 120-minute glucose disposal index, and the area under the glucose curve.
Considering that in patients who progress to T2DM, these alternative measures of insulin secretion and insulin sensitivity are always low and difficult to evaluate.
Therefore, OGTT (1h-PG) can also predict the progression of T2DM more accurately than IFG, IGT and HbA1c.
The current diagnostic threshold for diabetes is based on the correlation between blood glucose levels and diabetic retinopathy, especially non-proliferative diabetic retinopathy.
Previous studies have shown that OGTT (1h-PG) is significantly related to the incidence and incidence of diabetic retinopathy in American Indians, and is also significantly related to the incidence of diabetic retinopathy in the Swedish population.
A number of studies have shown that OGTT (1h-PG) is related to cardiovascular prognosis and mortality.
In addition, in the Malmö prevention project, OGTT (1h-PG) is more predictive of cardiovascular death and all-cause mortality than OGTT (2h-PG) in non-diabetic male subjects.
Studies on people of different races have shown that OGTT (1h-PG) blood glucose ≥8.
6mmol/L is a more accurate predictor of T2DM than IFG, IGT, HbA1c or the combination.
Therefore, an expert group has proposed that OGTT (1h-PG) blood glucose ≥ 8.
6mmol/level to define pre-diabetes.
In addition, some studies have found that OGTT (1h-PG) is more closely related to insulin secretion, and it can shorten the detection time.
Several other studies have shown that compared with FPG and HbA1c, OGTT (1h-PG) blood glucose has a better and more independent association with cardiovascular disease and all-cause death.
In this study, researchers evaluated the potential of OGTT (1h-PG) for the diagnosis of T2DM.
Research Overview This meta-analysis included a total of 15 related studies (n=35,551), aiming to explore the OGTT (1h-PG) blood glucose cut-off point for the diagnosis of T2DM, and included multi-ethnic populations, including white people and American Indians.
People, Japanese, Mexican American and South Asian population (non-white accounted for 46.
2%).
The researchers used OGTT (2h-PG) blood glucose as a standard of 11.
1mmol/L, and non-diabetic people [OGTT (2h-PG) blood glucose <11.
1mmol/L] as a control group to compare and analyze OGTT (1h-PG) blood glucose .
In order to determine the optimal OGTT (1h-PG) blood glucose cut-off point, in the random effects model, the researchers selected the λ value that is the best combination of specificity and sensitivity.
OGTT (1h-PG) 11.
6 mmol/L may be used as a diagnostic cut point for diabetes, with high sensitivity and specificity.
The results of this meta-analysis show: OGTT (1h-PG) blood glucose 11.
6 mmol/L is used as the diagnostic cut point for T2DM In comparison, OGTT (2h-PG) has good sensitivity (92%) and specificity (91%). The cut-off value has a sensitivity of 92% and a specificity of 91%.
What does it mean? The criterion for judging whether the cut point is effective is whether it can distinguish disease individuals with high accuracy, that is, how sensitive and specific the cut point is.
➤Sensitivity: refers to the percentage of "true positive" in the positive laboratory test results.
The closer the sensitivity is to 100%, the more "true positive" patients can be detected at the cut point; ➤Specificity: refers to the negative test results The percentage of "true negative" in the test results, the closer the specificity is to 100%, the more the cut point can exclude the "false negative" people who are not sick.
Specifically: ➤ Sensitivity 92%: Taking OGTT (1-h PG) 11.
6mmol/L as the cut point, 2489 cases (92%) of 2705 T2DM patients can be detected, but 216 cases (8%) were missed; ➤Specificity 91%: Taking OGTT (1-h PG) 11.
6mmol/L as the cut point can correctly classify 31,164 (91%) of the 32,246 non-diabetic people as non-diabetic patients, but 3082 people (9 %) Wrongly classified as diabetic patients, that is, the false positive rate is higher.
Adopt standardized diagnostic procedures, or reduce the proportion of false positives.
Researchers pointed out that it is not recommended to use OGTT for T2DM (or pre-diabetes) screening because of low feasibility and economic considerations.
Advocate the use of validated diabetes risk screening scores (such as the Finnish diabetes risk score) to identify high-risk groups, and further OGTT laboratory testing for high-risk groups may help reduce the proportion of false positives.
Summary of this article To sum up, this meta-analysis shows that: OGTT (1h-PG) 11.
6mmol/L or can be used as a diagnostic cut-off point for T2DM, compared with OGTT (2h-PG) ≥ 11.
1mmol/L has high sensitivity And specificity.
In order to improve the reliability of this indicator, further research is needed in the following areas: first, it is recommended to conduct more reproducible studies to verify the results; second, it is recommended to conduct a population-based longitudinal study to compare 1h-PG And 2h-PG and diabetic retinopathy and other microvascular complications, cardiovascular complications and all-cause mortality.
References: [1] Vasudha Ahuja, Pasi Aronen, TA Pramodkumar, et al.
Accuracy of 1-Hour Plasma Glucose During the Oral Glucose Tolerance Test in Diagnosis of Type 2 Diabetes in Adults: A Meta-analysis Diabetes Care.
2021; 44 :1062–1069.
https://doi.
org/10.
2337/dc20-1688.
