Glucose patterns during the OGTT and risk of future diabetes in an urban Indian population: The CARRS study
Glucose patterns during the OGTT and risk of future diabetes in an urban Indian population: The CARRS study
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DOI：
10.1016/j.diabres.2017.01.009
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发表时间：
2017-04-01
影响因子：
5.1
通讯作者：
Witte, Daniel R.
中科院分区：
文献类型：
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作者：
Hulman, Adam;Gujral, Unjali P.;Witte, Daniel R.
目的：传统上，空腹和攻毒后2小时血糖已被用于诊断糖尿病。然而，有证据表明，临床相关的病理生理信息，可以通过添加中间时间点的标准口服葡萄糖耐量试验（OGTT）。方法：我们研究了一个基于人口的样本3666亚洲印度人没有糖尿病的CARRS-钦奈研究，印度。参与者在基线时接受了三点（空腹、30分钟和2小时）OGTT。OGTT期间的血糖反应模式采用潜在类混合效应模型进行鉴定。经过两年的中位随访，参与者进行了第二次OGTT。Logistic回归调整糖尿病的危险因素被用来比较风险事件糖尿病之间的参与者在不同的潜在class.Results：我们确定了四个潜在类不同的葡萄糖模式（类1-4）。在所有三个时间点，1类、2类和4类的葡萄糖值排名一致，但水平逐渐升高。然而，3级代表了一种独特的模式，其特征是高30分钟（30 minPG），正常空腹（FPG）和2小时（2 hPG）血糖，中度高胰岛素敏感性，低急性胰岛素反应。大约22%的参与者被归类为3级，并有10倍的糖尿病风险相比，最有利的葡萄糖反应组，尽管92.5%的3级参与者具有正常的葡萄糖耐量（NGT）在baseline.Conclusions：升高30分钟PG与糖尿病的高风险事件，即使在个人归类为NGT由传统的OGTT。评估30 minPG可能会发现一个亚组的高风险个人谁仍然无法识别的传统措施。(C)2017年爱思唯尔B。V.保留所有权利。
Aims: Traditionally, fasting and 2-hour post challenge plasma glucose have been used to diagnose diabetes. However, evidence indicates that clinically relevant pathophysiological information can be obtained by adding intermediate time-points to a standard oral glucose tolerance test (OGTT).Methods: We studied a population-based sample of 3666 Asian Indians without diabetes from the CARRS-Chennai Study, India. Participants underwent a three-point (fasting, 30-min, and 2-h) OGTT at baseline. Patterns of glycemic response during OGTT were identified using latent class mixed-effects models. After a median follow-up of two years, participants had a second OGTT. Logistic regression adjusted for diabetes risk factors was used to compare risk of incident diabetes among participants in different latent classes.Results: We identified four latent classes with different glucose patterns (Classes 1-4). Glucose values for Classes 1, 2, and 4 ranked consistently at all three time-points, but at gradually higher levels. However, Class 3 represented a distinct pattern, characterized by high 30-min (30 minPG), normal fasting (FPG) and 2-h (2hPG) plasma glucose, moderately high insulin sensitivity, and low acute insulin response. Approximately 22% of participants were categorized as Class 3, and had a 10-fold risk of diabetes compared to the group with the most favorable glucose response, despite 92.5% of Class 3 participants having normal glucose tolerance (NGT) at baseline.Conclusions: Elevated 30 minPG is associated with high risk of incident diabetes, even in individuals classified as NGT by a traditional OGTT. Assessing 30 minPG may identify a subgroup of high-risk individuals who remained unidentified by traditional measures. (C) 2017 Elsevier B. V. All rights reserved.