Enhanced Predictive Capability of a 1-Hour Oral Glucose Tolerance Test: A Prospective Population-Based Cohort Study
Enhanced Predictive Capability of a 1-Hour Oral Glucose Tolerance Test: A Prospective Population-Based Cohort Study
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DOI：
10.2337/dc17-1351
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发表时间：
2018-01-01
期刊：
影响因子：
16.2
通讯作者：
Olsen, Michael H.
中科院分区：
文献类型：
--
作者：
Pareek, Manan;Bhatt, Deepak L.;Olsen, Michael H.
研究设计与方法我们进行了一项前瞻性的基于人群的队列研究，从1921至1949年间指定的出生队列中随机选择了4867名男性，他们接受了口服葡萄糖耐量试验，分别在0、1和2小时进行血糖测量。受试者被跟踪了长达39年，并基于登记记录事件。用Kaplan-Meier分析、Cox比例风险回归和净重分类改进方法比较血糖升高1 h(8.6 mmoL/L)和2 h(7.8 mmo1/L)对2型糖尿病发病、血管并发症和死亡率的预测能力。结果中位年龄48岁(四分位数范围48-49)。在随访期间(中位数33年[IQR 24-37])，636人(13%)发展为2型糖尿病。1小时血糖升高与糖尿病相关(危险比3.4[95%可信区间2.90-3.98]，P<；0.001)，并且比糖耐量受损提供更好的风险评估(哈瑞尔协调指数0.637比0.511，P<；0.001)。在按空腹血糖分层的受试者中，增加1小时测量比增加2小时测量提供了更大的净重新分类改善(分别为0.214比0.016)。结论1-h血糖水平比2-h血糖水平更能预测未来2型糖尿病的发生，并与糖尿病并发症和死亡率相关。
OBJECTIVETo 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 METHODSWe conducted a prospective population-based cohort study of 4,867 men, randomly selected from prespecified 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, and mortality were compared using Kaplan-Meier analysis, Cox proportional hazards regression, and net reclassification improvement.RESULTSMedian age was 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 associated with 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-h measurement 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.CONCLUSIONSThe 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.