Is the 1st Hour Plasma Glucose Level in OGTT an Important Parameter in Children with Normal Glucose Tolerance?

Abstract Background Type 2 diabetes mellitus (DM) and pre-DM, newly diagnosed after MI in patients without known DM adversely affects prognosis. 2-hour post-load glucose (2h-PG) predicts post-MI prognosis better than fasting plasma glucose (FPG). Plasma glucose below the conventional threshold for the diagnosis of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), affects post-MI prognosis. Purpose To test whether high-normal post-load plasma glucose in patients with normal glucose tolerance (NGT) would affect post-MI prognosis and whether FPG or 2h-PG increases this risk. Methods Retrospective cohort analysis of 425 MI survivors without known DM and with NGT followed up for (death and non-fatal MI) as MACE. MACE in patients with 2h-PG > median for the whole cohort (Group 2), was compared with those at or below (Group 1). Event free survival in the two groups was estimated from the Kaplan–Meier curves and compared using log-rank test. Cox proportional hazard regression identified predictors of MACE. Continuous net reclassification improvement (NRI>0) and integrated discrimination improvement (IDI) and c-statistics determined the added predictive value of glycaemic matrices. Results Median 2h-PG was 6.3 mmol/l. 219 patients in Group 1 and 206 in Group 2. Group 2 had higher age, prevalence of hypertension, hypercholesterolaemia, ST-segment depression and higher heart rate and GRACE scores. Median follow-up was 40.6 months. MACE was more frequent in Group 2 than Group 1 (OR 2.82, 95% CI 1.55 to 5.16, p<0.001). MACE-free survival was higher in Group 1 (HR 2.43, 95% CI 1.53 to 3.85, p<0.001). Group 2 (HR 2.42, 95% CI 1.44 to 4.04, p<0.001) predicted the MACE-free survival. 2h-PG, but not the FPG independently predicted of MACE (HR 1.73, 95% CI 1.31 to 2.30, p<0.001). Addition of 2h-PG to models containing FPG and other variables improved their predictive performance (NRI>0 0.5062, p<0.001; IDI 0.0376, p=0.003). The c-statistic increased when 2h-PG was added to the GRACE score only model (δAUC 0.037, 95% CI 0.012 to 0.081, p=0.046). Conclusion(s) This study suggests that “high-normal” 2h-PG is an independent predictor of post-MI prognosis. Normoglycaemic patients with 2h-PG ≥6.4 mmol/l, had worse post-MI prognosis compared to those with 2h-PG ≤6.3 mmol/l. The risk of MACE increased with increasing 2h-PG within the normal range. FPG had no effect on prognosis. Funding Acknowledgement Type of funding source: None

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THE RESPONSE OF INFANTS OF DIABETIC WOMEN TO TOLBUTAMIDE AND LEUCINE AT BIRTH, AND TO GLUCOSE AND TOLBUTAMIDE AT 2 YEARS OF AGE

PEDIATRICS ◽

10.1542/peds.43.4.546 ◽

1969 ◽

Vol 43 (4) ◽

pp. 546-557

Author(s):

Mutya S. A. Velasco ◽

Elsa P. Paulsen

Keyword(s):

Glucose Tolerance ◽

Plasma Glucose ◽

Newborn Infants ◽

Normal Glucose Tolerance ◽

Diabetic Woman ◽

Oral Glucose ◽

Insulin Levels ◽

Glucose Levels ◽

Normal Glucose ◽

Diabetic Mothers

Twelve newborn infants, 2 to 8 days old, of gestational (IGDM) and insulin-requiring (IDM) diabetic mothers responded to intravenous tolbutamide (20 mg/kg) with abnormally large decreases in plasma glucose and marked rises in plasma insulin (the latter was measured only in IGDM). Only 3 of 13 IGDM tested with leucine had significant decreases in plasma glucose. Newborn infants of normal mothers showed no changes in glucose or insulin in response to intravenous tolbutamide, and one of five had a small decrease in glucose levels after leucine. The results suggest the presence of large stores of pancreatic insulin in newborn infants of diabetic mothers which are more readily released by stimulation with tolbutamide than with leucine. The offspring of the diabetic women were restudied at 2 years of age for their response to intravenous tolbutamide and oral glucose. Seven of nine children had normal glucose and insulin levels after intravenous tolbutamide, and two had abnormally low glucose levels with high insulin levels. Three of the nine had normal glucose tolerance with normal insulin levels. The other six had abnormally elevated glucose levels which varied in duration from one-half to 2 hours. Four of the six had an accompanying hyperinsulinemia; two, who had diabetic glucose tolerance, had poor insulin responses. The findings in the 2-year-old children support a concept that the fetal environment provided by a diabetic woman has effects on carbohydrate tolerance which extend beyond the newborn period.

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