1-h Glucose During Oral Glucose Tolerance Test Predicts Hyperglycemia Relapse-Free Survival in Obese Black Patients With Hyperglycemic Crises

• Type of Material: Article
• Authors: Ram Jagannathan, Emory University; Darko Stefanovski, University of Pennsylvania; Dawn D Smiley, Emory University; Omolade Oladejo, Emory University; Lucia F Cotten, Emory University; Guillermo Umpierrez, Emory University; Priyathama Vellanki, Emory University
• Language: English
• Date: 2022-06-02
• Publisher: FRONTIERS MEDIA SA
• Publication Version: Final Published Version
• Copyright Statement: © 2022 Jagannathan, Stefanovski, Smiley, Oladejo, Cotten, Umpierrez and Vellanki
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3389/fendo.2022.871965
• Title of Journal or Parent Work: FRONTIERS IN ENDOCRINOLOGY
• Volume: 13
• Start Page: 871965
• End Page: 871965
• Grant/Funding Information: PV is funded in part by NIH/NIDDK K23 DK 11324-01A1.; This study was funded by NIH K08 DK083036 to DDS. GU is partly supported by research grants from the NIH/NATS UL1 TR002378 from the Clinical and Translational Science Award program and 1P30DK111024-01 from NIH and National Center for Research Resources.
• Keywords: INSULIN-RESISTANCE; 1-h and 2-h glucose values; Life Sciences & Biomedicine; NEAR-NORMOGLYCEMIC REMISSION; net reclassification improvement; AFRICAN-AMERICAN PATIENTS; oral glucose tolerance; Science & Technology; HISTORY; ROC (receiver operating characteristic curve); Endocrinology & Metabolism; diabetic ketoacidosis; stress hyperglycemia
• Research Categories: Biology, Biostatistics

Abstract

Objective: Approximately 50% of obese Black patients with unprovoked diabetic ketoacidosis (DKA) or severe hyperglycemia (SH) at new-onset diabetes achieve near-normoglycemia remission with intensive insulin treatment. Despite the initial near-normoglycemia remission, most DKA/SH individuals develop hyperglycemia relapse after insulin discontinuation. Traditional biomarkers such as normal glucose tolerance at the time of remission were not predictive of hyperglycemia relapse. We tested whether 1-h plasma glucose (1-h PG) at remission predicts hyperglycemia relapse in Black patients with DKA/SH. Methods: Secondary analysis was performed of two prospective randomized controlled trials in 73 patients with DKA/SH at the safety net hospital with a median follow-up of 408 days. Patients with DKA/SH underwent a 5-point, 2-h 75-g oral glucose tolerance test after hyperglycemia remission. Hyperglycemia relapse is defined by fasting blood glucose (FBG) > 130 mg/dl, random blood glucose (BG) >180 mg/dl, or HbA1c > 7%. Results: During the median 408 (interquartile range: 110–602) days of follow-up, hyperglycemia relapse occurred in 28 (38.4%) participants. One-hour PG value ≥199 mg/dl discriminates hyperglycemia relapse (sensitivity: 64%; specificity: 71%). Elevated levels of 1-h PG (≥199 mg/dl) were independently associated with hyperglycemia relapse (adjusted hazard ratio: 2.40 [95% CI: 1.04, 5.56]). In a multivariable model with FBG, adding 1-h PG level enhanced the prediction of hyperglycemia relapse, with significant improvements in C-index (Δ: +0.05; p = 0.04), net reclassification improvement (NRI: 48.7%; p = 0.04), and integrated discrimination improvement (IDI: 7.8%; p = 0.02) as compared with the addition of 2-h PG (NRI: 20.2%; p = 0.42; IDI: 1.32%; p = 0.41) or HbA1c (NRI: 35.2%; p = 0.143; IDI: 5.8%; p = 0.04). Conclusion: One-hour PG at the time of remission is a better predictor of hyperglycemia relapse than traditional glycemic markers among obese Black patients presenting with DKA/SH. Testing 1-h PG at insulin discontinuation identifies individuals at high risk of developing hyperglycemia relapse.