Enhanced predictive capability of a 1-hour oral glucose tolerance test: A prospective population-based cohort study

Manan Pareek; Deepak L. Bhatt; Mette L. Nielsen; Ram Jagannathan; Karl Fredrik Eriksson; Peter M. Nilsson; Michael Bergman; Michael H. Olsen

doi:10.2337/dc17-1351

Enhanced predictive capability of a 1-hour oral glucose tolerance test: A prospective population-based cohort study

Manan Pareek^*
, Deepak L. Bhatt
, Mette L. Nielsen
, Ram Jagannathan
, Karl Fredrik Eriksson
, Peter M. Nilsson
, Michael Bergman
, Michael H. Olsen

^*Corresponding author for this work

Medicine (HOL)

Research output: Contribution to journal › Article › Research › peer-review

Abstract

OBJECTIVE To examine whether the 1-h blood glucose measurement would be a more suitable screening tool for assessing the risk of diabetes and its complications than the 2-h measurement. RESEARCH DESIGN AND METHODS We conducted a prospective population-based cohort study of 4,867men, randomly selected fromprespecified birth cohorts between 1921 and 1949,who underwent an oral glucose tolerance test with blood glucose measurements at 0, 1, and 2 h. Subjects were followed for up to 39 years, with registry-based recording of events. Discriminative abilities of elevated 1-h (≥8.6 mmol/L) versus 2-h (≥7.8 mmol/L) glucose for predicting incident type 2 diabetes, vascular complications, andmortality were compared using Kaplan-Meier analysis, Cox proportional hazards regression, and net reclassification improvement. RESULTS Median agewas 48 years (interquartile range [IQR] 48-49). During follow-up (median 33 years [IQR 24-37]), 636 (13%) developed type 2 diabetes. Elevated 1-h glucose was associatedwith incident diabetes (hazard ratio 3.40 [95% CI 2.90-3.98], P < 0.001) and provided better risk assessment than impaired glucose tolerance (Harrell concordance index 0.637 vs. 0.511, P < 0.001). Addition of a 1-hmeasurement in subjects stratified by fasting glucose provided greater net reclassification improvement than the addition of a 2-h measurement (0.214 vs. 0.016, respectively). Finally, the 1-h glucose was significantly associated with vascular complications and mortality. CONCLUSIONS The 1-h blood glucose level is a stronger predictor of future type 2 diabetes than the 2-h level and is associated with diabetes complications and mortality.

Original language	English
Pages (from-to)	171-177
Number of pages	7
Journal	Diabetes Care
Volume	41
Issue number	1
DOIs	https://doi.org/10.2337/dc17-1351
Publication status	Published - 1 Jan 2018

Funding

thank data managers Anders Dahlin and Håkan Andersson at the Department of Clinical Sciences, Lund University, Skåne University Hospital, for help with retrieving data. FundingandDualityofInterest.This study was funded by the Danish Diabetes Academy, supported by the Novo Nordisk Foundation. D.L.B. discloses the following relationships: Advisory board, Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; Board of directors, Boston VA Research Institute and Society of Cardiovascular Patient Care; Chair, American Heart Association Quality OversightCommittee;Data-monitoringcommit-tees, Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, and Population Health Research Institute; honoraria, American College of Cardiology (Senior Associate Editor, Clinical Trials and News, acc. org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor, Associate Editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), and WebMD (CME steering committees); other, Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), and VA CART Research and Publications Committee (Chair); research funding, Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi, and The Medicines Company; royalties, Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); site co-investigator, Biotronik, Boston Scientific, and St. Jude Medical (now Abbott); trustee, American College of Cardiology; and unfunded research, FlowCo, Merck, PLx Pharma, and Takeda. M.H.O. discloses receipt of a part-time clinical research grant from the Novo Nordisk Foundation. No other potential conflicts of interest relevant to this article were reported. Author Contributions. M.P. conceptualized the hypothesis, designed the work, analyzed and interpreted data, drafted the manuscript, and revised the manuscript critically for important intellectual content. D.L.B. and M.H.O. conceptualized the hypothesis, designed the work, interpreted data, and revised the manuscript critically for important intellectual content. M.L.N., R.J., K.-F.E., P.M.N., and M.B. conceptualized the hypothesis, interpreted data, and

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title = "Enhanced predictive capability of a 1-hour oral glucose tolerance test: A prospective population-based cohort study",

abstract = "OBJECTIVE To examine whether the 1-h blood glucose measurement would be a more suitable screening tool for assessing the risk of diabetes and its complications than the 2-h measurement. RESEARCH DESIGN AND METHODS We conducted a prospective population-based cohort study of 4,867men, randomly selected fromprespecified birth cohorts between 1921 and 1949,who underwent an oral glucose tolerance test with blood glucose measurements at 0, 1, and 2 h. Subjects were followed for up to 39 years, with registry-based recording of events. Discriminative abilities of elevated 1-h (≥8.6 mmol/L) versus 2-h (≥7.8 mmol/L) glucose for predicting incident type 2 diabetes, vascular complications, andmortality were compared using Kaplan-Meier analysis, Cox proportional hazards regression, and net reclassification improvement. RESULTS Median agewas 48 years (interquartile range [IQR] 48-49). During follow-up (median 33 years [IQR 24-37]), 636 (13\%) developed type 2 diabetes. Elevated 1-h glucose was associatedwith incident diabetes (hazard ratio 3.40 [95\% CI 2.90-3.98], P < 0.001) and provided better risk assessment than impaired glucose tolerance (Harrell concordance index 0.637 vs. 0.511, P < 0.001). Addition of a 1-hmeasurement in subjects stratified by fasting glucose provided greater net reclassification improvement than the addition of a 2-h measurement (0.214 vs. 0.016, respectively). Finally, the 1-h glucose was significantly associated with vascular complications and mortality. CONCLUSIONS The 1-h blood glucose level is a stronger predictor of future type 2 diabetes than the 2-h level and is associated with diabetes complications and mortality.",

author = "Manan Pareek and Bhatt, \{Deepak L.\} and Nielsen, \{Mette L.\} and Ram Jagannathan and Eriksson, \{Karl Fredrik\} and Nilsson, \{Peter M.\} and Michael Bergman and Olsen, \{Michael H.\}",

year = "2018",

month = jan,

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doi = "10.2337/dc17-1351",

language = "English",

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pages = "171--177",

journal = "Diabetes Care",

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T1 - Enhanced predictive capability of a 1-hour oral glucose tolerance test

T2 - A prospective population-based cohort study

AU - Pareek, Manan

AU - Bhatt, Deepak L.

AU - Nielsen, Mette L.

AU - Jagannathan, Ram

AU - Eriksson, Karl Fredrik

AU - Nilsson, Peter M.

AU - Bergman, Michael

AU - Olsen, Michael H.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - OBJECTIVE To examine whether the 1-h blood glucose measurement would be a more suitable screening tool for assessing the risk of diabetes and its complications than the 2-h measurement. RESEARCH DESIGN AND METHODS We conducted a prospective population-based cohort study of 4,867men, randomly selected fromprespecified birth cohorts between 1921 and 1949,who underwent an oral glucose tolerance test with blood glucose measurements at 0, 1, and 2 h. Subjects were followed for up to 39 years, with registry-based recording of events. Discriminative abilities of elevated 1-h (≥8.6 mmol/L) versus 2-h (≥7.8 mmol/L) glucose for predicting incident type 2 diabetes, vascular complications, andmortality were compared using Kaplan-Meier analysis, Cox proportional hazards regression, and net reclassification improvement. RESULTS Median agewas 48 years (interquartile range [IQR] 48-49). During follow-up (median 33 years [IQR 24-37]), 636 (13%) developed type 2 diabetes. Elevated 1-h glucose was associatedwith incident diabetes (hazard ratio 3.40 [95% CI 2.90-3.98], P < 0.001) and provided better risk assessment than impaired glucose tolerance (Harrell concordance index 0.637 vs. 0.511, P < 0.001). Addition of a 1-hmeasurement in subjects stratified by fasting glucose provided greater net reclassification improvement than the addition of a 2-h measurement (0.214 vs. 0.016, respectively). Finally, the 1-h glucose was significantly associated with vascular complications and mortality. CONCLUSIONS The 1-h blood glucose level is a stronger predictor of future type 2 diabetes than the 2-h level and is associated with diabetes complications and mortality.

AB - OBJECTIVE To examine whether the 1-h blood glucose measurement would be a more suitable screening tool for assessing the risk of diabetes and its complications than the 2-h measurement. RESEARCH DESIGN AND METHODS We conducted a prospective population-based cohort study of 4,867men, randomly selected fromprespecified birth cohorts between 1921 and 1949,who underwent an oral glucose tolerance test with blood glucose measurements at 0, 1, and 2 h. Subjects were followed for up to 39 years, with registry-based recording of events. Discriminative abilities of elevated 1-h (≥8.6 mmol/L) versus 2-h (≥7.8 mmol/L) glucose for predicting incident type 2 diabetes, vascular complications, andmortality were compared using Kaplan-Meier analysis, Cox proportional hazards regression, and net reclassification improvement. RESULTS Median agewas 48 years (interquartile range [IQR] 48-49). During follow-up (median 33 years [IQR 24-37]), 636 (13%) developed type 2 diabetes. Elevated 1-h glucose was associatedwith incident diabetes (hazard ratio 3.40 [95% CI 2.90-3.98], P < 0.001) and provided better risk assessment than impaired glucose tolerance (Harrell concordance index 0.637 vs. 0.511, P < 0.001). Addition of a 1-hmeasurement in subjects stratified by fasting glucose provided greater net reclassification improvement than the addition of a 2-h measurement (0.214 vs. 0.016, respectively). Finally, the 1-h glucose was significantly associated with vascular complications and mortality. CONCLUSIONS The 1-h blood glucose level is a stronger predictor of future type 2 diabetes than the 2-h level and is associated with diabetes complications and mortality.

UR - https://www.scopus.com/pages/publications/85038961961

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DO - 10.2337/dc17-1351

M3 - Article

C2 - 29138275

AN - SCOPUS:85038961961

SN - 0149-5992

VL - 41

SP - 171

EP - 177

JO - Diabetes Care

JF - Diabetes Care

IS - 1

ER -

Enhanced predictive capability of a 1-hour oral glucose tolerance test: A prospective population-based cohort study

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