Abstract | BACKGROUND: Increased fasting plasma glucose (FPG) and 2-hour postchallenge plasma glucose ( PCPG) levels with normal hemoglobin A1c (HbA1c) levels are recognized as risk factors for cardiovascular disease. We undertook this study to determine the relationships between FPG and 2-hour PCPG levels over the normal HbA1c range and to assess the need to control FPG and 2-hour PCPG levels to achieve HbA1c targets recommended by the American Diabetes Association (ADA), International Diabetes Federation (IDF), and American College of Endocrinology (ACE). METHODS: The data of all healthy individuals with HbA1c values less than 7.0% (N = 457) who underwent oral glucose tolerance tests between 1986 and 2002 for either screening as potential research volunteers (93%) or diagnostic purposes (7%) were analyzed. RESULTS: Of 404 individuals with normal HbA1c levels (<6.0%), 60% had normal glucose tolerance, 33% had impaired glucose tolerance, 1% had isolated impaired FPG, and 6% had type 2 diabetes mellitus. Of 161 individuals without normal glucose tolerance, 80% had normal FPG levels. Both FPG and 2-hour PCPG levels increased as HbA1c increased and were significantly correlated (r = 0.63, P<.001), but the 2-hour PCPG level increased at a rate 4 times greater than FPG and accounted for a greater proportion of HbA1c. People who met the IDF and ACE HbA1c targets (<6.5%) had significantly lower 2-hour PCPG levels than those who met the ADA target (<7.0%) (P =.03), whereas FPG levels were similar. CONCLUSIONS: Most individuals with HbA1c values between 6.0% and 7.0% have normal FPG levels but abnormal 2-hour PCPG levels, suggesting that an upper limit of normal for FPG at 110 mg/dL (6.11 mmol/L) is too high and that attempts to lower HbA1c in these individuals will require treatment preferentially directed at lowering postprandial glucose levels.
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Authors | Hans J Woerle, Walkyria P Pimenta, Christian Meyer, Niyaz R Gosmanov, Ervin Szoke, Tamas Szombathy, Asimina Mitrakou, John E Gerich |
Journal | Archives of internal medicine
(Arch Intern Med)
2004 Aug 9-23
Vol. 164
Issue 15
Pg. 1627-32
ISSN: 0003-9926 [Print] United States |
PMID | 15302632
(Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)
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Chemical References |
- Blood Glucose
- Glycated Hemoglobin A
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Topics |
- Adult
- Blood Glucose
(analysis)
- Diabetes Mellitus, Type 2
(diagnosis)
- Fasting
(blood)
- Female
- Glucose Metabolism Disorders
(diagnosis)
- Glucose Tolerance Test
(methods)
- Glycated Hemoglobin
(metabolism)
- Humans
- Linear Models
- Male
- Middle Aged
- Multivariate Analysis
- Postprandial Period
- Reference Values
- Sensitivity and Specificity
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