The significance of impaired fasting glucose versus impaired glucose tolerance - Importance of insulin secretion and resistance

被引:126
作者
Schianca, GPC
Rossi, A
Sainaghi, PP
Maduli, E
Bartoli, E
机构
[1] Univ Piemonte Orientale A Avogadro, Dipartimento Sci Med, I-28100 Novara, Italy
[2] Osped Maggiore Novara, I-28100 Novara, Italy
关键词
D O I
10.2337/diacare.26.5.1333
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE - The American Diabetes Association recommended substituting 2hBS (glycemia at the second hour of an oral glucose tolerance test [OGTT]) for fasting blood glucose (FBS) in screening for glucose intolerance. it is debated whether these tests measure the same abnormality and relate to defective insulin secretion or resistance, This study examines the diagnostic effectiveness of FBS versus 2hBS and their relationship with insulin secretion and resistance. RESEARCH DESIGN AND METHODS - Based on history or physical findings suggesting glucose intolerance, we enrolled 398 unselected subjects admitted to a general Internal Medicine ward. After 5 days of a weight-maintaining diet, FBS, 2hBS, and insulin were measured during OGTT. The homeostatic model assessment was used to assess beta-cell function and insulin resistance. RESULTS - Excluding 19 patients with diabetes (5%), we identified 284 subjects with normal glucose tolerance (NGT), 22 with isolated impaired fasting glucose (IFG), 59 with isolated impaired glucose tolerance (IGT), and 14 with associated IFG/IGT. The sensitivity of FBS in predicting 2hBS was 19%, specificity 93%. Positive and negative predictive values were 39% and 83%, respectively. Insulin resistance was absent in NGT and IFG and markedly elevated in IGT and IFG/IGT, whereas detective insulin release was significant only in isolated IFG. CONCLUSIONS - in unselected patients, elevated FBS depends primarily on defective insulin secretion, and impaired 2hBS on insulin resistance. Because these tests measure different alterations, they are useful in combination.
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页码:1333 / 1337
页数:5
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