The Significance of Impaired Fasting Glucose Versus Impaired Glucose Tolerance
Importance of insulin secretion and resistance
- Gian Piero Carnevale Schianca, MD,
- Antonello Rossi, MD,
- Pier Paolo Sainaghi, MD,
- Elisabetta Maduli, MD and
- Ettore Bartoli, MD
- From the Dipartimento di Scienze Mediche (Internal Medicine), Università del Piemonte Orientale “A. Avogadro” and Ospedale “Maggiore della Carità,” Novara, Italy
OBJECTIVE—The American Diabetes Association recommended substituting 2hBS (glycemia at the second hour of an oral glucose tolerance test [OGTT]) for fasting blood glucose (FBS) in screening for glucose intolerance. It is debated whether these tests measure the same abnormality and relate to defective insulin secretion or resistance. This study examines the diagnostic effectiveness of FBS versus 2hBS and their relationship with insulin secretion and resistance.
RESEARCH DESIGN AND METHODS—Based on history or physical findings suggesting glucose intolerance, we enrolled 398 unselected subjects admitted to a general Internal Medicine ward. After 5 days of a weight-maintaining diet, FBS, 2hBS, and insulin were measured during OGTT. The homeostatic model assessment was used to assess β-cell function and insulin resistance.
RESULTS—Excluding 19 patients with diabetes (5%), we identified 284 subjects with normal glucose tolerance (NGT), 22 with isolated impaired fasting glucose (IFG), 59 with isolated impaired glucose tolerance (IGT), and 14 with associated IFG/IGT. The sensitivity of FBS in predicting 2hBS was 19%, specificity 93%. Positive and negative predictive values were 39% and 83%, respectively. Insulin resistance was absent in NGT and IFG and markedly elevated in IGT and IFG/IGT, whereas defective insulin release was significant only in isolated IFG.
CONCLUSIONS—In unselected patients, elevated FBS depends primarily on defective insulin secretion, and impaired 2hBS on insulin resistance. Because these tests measure different alterations, they are useful in combination.
- 2hBS, second-hour glycemia after oral load
- ADA, American Diabetes Association
- FBS, fasting blood glucose
- HOMA, homeostatic model assessment
- IFG, impaired fasting glucose
- IGT, impaired glucose tolerance
- IR, insulin resistance
- ISI, insulin sensitivity index
- NGT, normal glucose tolerance
- OGTT, oral glucose tolerance test
- WHO, World Health Organization
- WHR, waist-to-hip ratio
Address correspondence and reprint requests to Ettore Bartoli, Dipartimento di Scienze Mediche, Università del Piemonte Orientale “A. Avogadro,” via Solaroli 17, 28100 Novara Italy. E-mail:.
Received for publication 16 July 2002 and accepted in revised form 5 February 2003.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
- DIABETES CARE