Minimal Contribution of Fasting Hyperglycemia to the Incidence of Type 2 Diabetes in Subjects With Normal 2-h Plasma Glucose

Muhammad A. Abdul-Ghani; Michael P. Stern; Valeriya Lyssenko; Tiinamaija Tuomi; Leif Groop; Ralph A. DeFronzo

doi:10.2337/dc09-1145

Minimal Contribution of Fasting Hyperglycemia to the Incidence of Type 2 Diabetes in Subjects With Normal 2-h Plasma Glucose

Muhammad A. Abdul-Ghani, MD, PHD¹,
Michael P. Stern, MD²,
Valeriya Lyssenko, MD, PHD³,
Tiinamaija Tuomi, MD, PHD³,
Leif Groop, MD³ and
Ralph A. DeFronzo, MD³

¹Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, Texas;
²Division of Clinical Epidemiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas;
³Department of Clinical Sciences, Diabetes and Endocrinology and Lund University Diabetes Center, Lund University, Malmö, Sweden.

Corresponding author: Muhammad A. Abdul-Ghani, abdulghani{at}uthscsa.edu.

Diabetes Care 2010 Mar; 33(3): 557-561. https://doi.org/10.2337/dc09-1145

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Figure 1
Seven- to 8-year incidence of type 2 diabetes (T2DM) in subjects with normal fasting glucose (FPG <100 mg/dl) and impaired fasting glucose (FPG 100–125 mg/dl). Subjects were divided into six groups according to fixed intervals of 1-h plasma glucose concentration as follows: <100, 100–125, 125–150, 150–175, 175–200, and >200 mg/dl. The mean 1-h plasma glucose concentration (n) in subjects with FPG <100 mg/dl was 85 (652), 113 (732), 139 (634), 165 (206), and 192 (187) mg/dl and in subjects with FPG >110 mg/dl was 91 (104), 114 (224), 140 (333), 165 (158), 193 (169), and 241 (51) mg/dl, respectively. None of the subjects with FPG <100 mg/dl had a 1-h plasma glucose concentration >200 mg/dl.

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Table 1

Baseline patient characteristics in the SAHS and Botnia Study

	SAHS	Botnia Study	P
n	1,390	2,060	<0.0001
Age (years)	43 ± 03	45 ± 0.3	<0.0001
Sex (% male)	56	52.9	<0.0001
BMI	27.3 ± 0.2	25.5 ± 0.1	<0.0001
Systolic blood pressure (mmHg)	117 ± 0.4	126 ± 0.4	<0.0001
Diastolic blood pressure (mmHg)	71 ± 0.3	94 ± 0.2	<0.0001
FPG (mg/dl)	85 ± 0.3	99 ± 0.2	<0.0001
1-h plasma glucose (mg/dl)	125 ± 1	133 ± 0.5	<0.0001
2-h plasma glucose (mg/dl)	96 ± 0.6	104 ± 0.5	<0.0001
HDL (mg/dl)	47 ± 0.4	54 ± 0.6	<0.0001
Triglycerides (mg/dl)	132 ± 2	108 ± 2	<0.0001
Type 2 diabetes incidence (%)	6.33	3.64	<0.0001

Table 2

Multivariate logistic model for the future risk of type 2 diabetes as the dependent variable and FPG, age, sex, BMI, ethnicity, family history for type 2 diabetes, blood pressure, and HDL cholesterol as the independent variables (model 1)

	SAHS		Botnia Study
	OR (95%CI)	P	OR (95% CI)	P
Model 1
Age	1.03 (1.004–1.05)	0.01	1.04 (1.02–1.06)	0.001
BMI	1.1 (1.06–1.14)	<0.0001	1.1 (1.04–1.18)	0.002
Ethnicity	0.53 (0.3–0.93	0.02	NA
Systolic blood pressure	1.01 (0.997–1.03)	NS	1.02 (1.002–1.03)	0.02
FPG	1.06 (1.04–1.08)	<0.0001	1.05 (1.02–1.08)	<0.0001
Model 2
1-h plasma glucose	1.03 (1.02–1.04)	<0.0001	1.02 (1.01–1.03)	<0.0001
Age	1.02 (0.99–1.04)	NS	1.04 (1.01–1.06)	0.004
BMI	1.08 (1.04–1.13)	<0.0001	1.07 (1.006–1.14)	0.03
Ethnicity	0.46 (0.256–0.83)	<0.01	NA
Systolic blood pressure	1.0 (0.98–1.02)	NS	1.01 (0.99–1.03)	NS
FPG	1.02 (0.99–1.05)	NS	1.02 (0.99–1.06)	NS
Model 3
2-h plasma glucose	1.02 (1.004–1.03)	0.007	1.04 (0.8–1.35)	NS
Age	1.02 (1.001–1.05)	0.04	1.04 (1.015–1.06)	0.001
BMI	1.09 (1.05–1.13)	<0.0001	1.09 (1.02–1.16)	0.01
Ethnicity	0.58 (0.316–0.985)	0.04	NA
Systolic blood pressure	1.0 (0.98–1.02)	NS	1.02 (1.01–1.03)	0.02
FPG	1.05 (1.03–1.08)	<0.0001	1.05 (1.02–1.08)	0.001

Data are ORs (95% CI) for the variables that were significant predictors of type 2 diabetes risk. In model 2, the 1-h plasma glucose concentration during the OGTT was added to model 1, and in model 3, the 2-h plasma glucose concentration during the OGTT was added to the model.

Table 3

Incidence of type 2 diabetes in subjects with NGT divided into three groups based on FPG

FPG (mg/dl)	1-h PG (mg/dl)	n (% of SAHS participants)	FPG (mg/dl)	1-h PG (mg/dl)	2-h PG (mg/dl)	OR (95% CI)
<90	<125	894 (72)	81 ± 1	95 ± 26	87 ± 11	1
	125–150	286 (73)	82 ± 6	135 ± 10	100 ± 22	4.7 (2.0–11.1)
	>150	219 (72)	83 ± 6	175 ± 19	109 ± 21	7.4 (3.3–17.1)
90–100	<125	489 (29)	95 ± 3	99 ± 14	94 ± 18	1.8 (0.6–5.2)
	125–150	255 (30)	95 ± 3	136 ± 10	105 ± 19	2.7 (1.1–6.9)
	>150	265 (34)	96 ± 3	180 ± 18	111 ± 20	11.3 (5.0–25.8)
>100	<125	329 (7)	106 ± 5	102 ± 12	101 ± 17	1.7 (0.4–6.7)
	125–150	277 (9)	107 ± 5	137 ± 10	108 ± 19	4.0 (1.3–12.5)
	>150	432 (10)	109 ± 6	188 ± 27	114 ± 18	17.7 (7.5–41.9)

Data are means ± SD unless indicated otherwise. Subjects with NGT were divided into three groups based on FPG <90, 90–100, and >100 mg/dl. Subjects in each group were further subdivided based on a 1-h plasma glucose (PG) concentration <125, 125–155, and >155 mg/dl. Age, BMI, ethnicity, and systolic blood pressure were included as covariates in the model.