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Diagnostic and therapeutic implications of relationships between fasting, 2-hour postchallenge plasma glucose and hemoglobin a1c values.
Arch Intern Med. 2004 Aug 9-23; 164(15):1627-32.AI

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.

Authors+Show Affiliations

Department of Medicine, University of Rochester School of Medicine, Rochester, NY 14642, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15302632

Citation

Woerle, Hans J., et al. "Diagnostic and Therapeutic Implications of Relationships Between Fasting, 2-hour Postchallenge Plasma Glucose and Hemoglobin A1c Values." Archives of Internal Medicine, vol. 164, no. 15, 2004, pp. 1627-32.
Woerle HJ, Pimenta WP, Meyer C, et al. Diagnostic and therapeutic implications of relationships between fasting, 2-hour postchallenge plasma glucose and hemoglobin a1c values. Arch Intern Med. 2004;164(15):1627-32.
Woerle, H. J., Pimenta, W. P., Meyer, C., Gosmanov, N. R., Szoke, E., Szombathy, T., Mitrakou, A., & Gerich, J. E. (2004). Diagnostic and therapeutic implications of relationships between fasting, 2-hour postchallenge plasma glucose and hemoglobin a1c values. Archives of Internal Medicine, 164(15), 1627-32.
Woerle HJ, et al. Diagnostic and Therapeutic Implications of Relationships Between Fasting, 2-hour Postchallenge Plasma Glucose and Hemoglobin A1c Values. Arch Intern Med. 2004 Aug 9-23;164(15):1627-32. PubMed PMID: 15302632.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic and therapeutic implications of relationships between fasting, 2-hour postchallenge plasma glucose and hemoglobin a1c values. AU - Woerle,Hans J, AU - Pimenta,Walkyria P, AU - Meyer,Christian, AU - Gosmanov,Niyaz R, AU - Szoke,Ervin, AU - Szombathy,Tamas, AU - Mitrakou,Asimina, AU - Gerich,John E, PY - 2004/8/11/pubmed PY - 2004/8/25/medline PY - 2004/8/11/entrez SP - 1627 EP - 32 JF - Archives of internal medicine JO - Arch Intern Med VL - 164 IS - 15 N2 - 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. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/15302632/Diagnostic_and_therapeutic_implications_of_relationships_between_fasting_2_hour_postchallenge_plasma_glucose_and_hemoglobin_a1c_values_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.164.15.1627 DB - PRIME DP - Unbound Medicine ER -