Clinical utility of 30-min plasma glucose for prediction of type 2 diabetes among people with prediabetes: Ancillary analysis of the diabetes community lifestyle improvement program

• Type of Material: Article
• Authors: Ram Jagannathan, Emory University; Mary Weber, Emory University; Ranjit M. Anjana, Madras Diabetes Research Foundation, Chennai, India; Harish Ranjani, Madras Diabetes Research Foundation, Chennai, India; Lisa Staimez, Emory University; Mohammed Ali, Emory University; Viswanathan Mohan, Madras Diabetes Research Foundation, Chennai, India; Kabayam Venkat Narayan, Emory University
• Language: English
• Date: 2020-03-01
• Publisher: Elsevier Ireland Ltd.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 Elsevier B.V.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.diabres.2020.108075
• Title of Journal or Parent Work: Diabetes Research and Clinical Practice
• Volume: 161
• Start Page: 108075
• End Page: 108075
• Grant/Funding Information: M.K.A. has received fundings from the National Institute of Diabetes, and Digestive and Kidney Diseases grant (Contract No. HHSN268200900026C); the United Health Group, Minneapolis, MN, USA.; Additional support was provided by the Global Health Institute at Emory University.; M.B.W and K.M.V.N. received funding from the National Heart, Lung, and Blood Institute grant R01HL125442.; This project is supported by a BRiDGES grant from the International Diabetes Federation (LT07-115). BRiDGES, an International Diabetes Federation project, is supported by an educational grant from Lilly Diabetes.; M.B.W, M.K.A, and K.M.V.N. have received grants from the National Institute of Diabetes, and Digestive and Kidney Diseases grant P30DK111024.; L.R.S received grants from the Human Health Molecules to Humankind program funded by the Burroughs Wellcome Fund grant (BWF 1008188).
• Keywords: Level; Predictive utility; Science & Technology; OGTT; Curve; Net reclassification improvement; Tolerance; Glycemia; High risk; Prediabetes; Diabetes prediction; Shape; Life Sciences & Biomedicine; Insulin secretonin; Endocrinology & Metabolism; Prevention; 30-min-plasma glucose
• Research Categories: Health Sciences, Public Health; Health Sciences, Pathology; Health Sciences, Medicine and Surgery

Abstract

Aims: To examine the clinical utility of 30-min plasma glucose (30-min-PG) measurement during an oral glucose tolerance (OGTT) in predicting type 2 diabetes (T2DM). Research design and methods: Data from a 3-year, randomized, controlled, primary prevention trial among 548 Asian Indians with prediabetes were analyzed. Participants underwent OGTT with PG measurements at fasting, 30-min, and 2-h at baseline and annually until the end of the study. Multivariable Cox regression models were constructed to calculate the risk of developing diabetes based on 30-min-PG levels. Improvement in prediction performance gained by adding an elevated level of 30-min-PG over prediabetic categories was calculated using the area-under-curve (AUC), net-reclassification (NRI), and integrated discrimination improvement (IDI) statistics. Results: At the end of follow-up, 30.4% of individuals had been diagnosed with T2DM by ADA criteria. Based on the maximally selected log-rank statistics, the optimal 30-min-PG cut point for predicting incident T2DM was >182 mg/dl. Multivariable-adjusted Cox regression models showed an independent association between elevated 30-min-PG (>182 mg/dl) and incident diabetes (hazard ratio (95% CI): 1.85 [1.32, 2.59]; Dxy = 0.353, c-statistic = 0.676). The addition of an elevated 30-min-PG (>182 mg/dl) model significantly improved the prediction of diabetes (Δdeviance: −15.4; ΔAUC: 0.11; NRIcontinuous: 0.51; IDI: 0.08) compared with IFG model alone) in individuals with prediabetes. Conclusion: In prediabetic individuals, baseline 30-min-PG independently predicted T2DM and significantly improved reclassification and discrimination. Therefore, 30-min-PG should be considered as part of the routine testing in addition to FPG and 2-h-PG for better risk stratification.