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Clinical implication of fasting and post-challenged plasma glucose in diagnosis of diabetes mellitus

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Abstract

Fasting plasma glucose (FPG) is the preferred test in diagnosis of diabetes mellitus (DM) to 2-h post-challenged plasma glucose (2hPG). There is little information available on the comparison between FPG and 2hPG diagnostic criteria. This study included adult participants (≥18 years old) of the NHANES 2005–2010 with FPG, 2hPG, and BMI measured. Subjects with established DM were excluded. The sensitivity of FPG and 2hPG diagnostic criteria was compared as the main outcome measure. Among 5,782 subjects, 476 subjects (8.23 %) were diagnosed with DM by either FPG, 2hPG, or both criteria. Among the subjects meeting the criterion of FPG, those with 2hPG <200 mg/dL were younger (57 ± 16 vs. 61 ± 15 years old, P < 0.05, mean ± STD) and less obese (30.81 ± 7.89 vs. 32.71 ± 6.68 kg/m2, P < 0.05) as compared to those with 2hPG ≥200 mg/dL. Among the subjects meeting the criterion of 2hPG, those with FPG <126 mg/dL were more female (55.41 vs. 39.88 %, P < 0.0002), less obese (29.24 ± 5.83 vs. 32.71 ± 6.68 kg/m2, P < 0.000001), lower diastolic blood pressure (67 ± 12 vs. 71 ± 14 mmHg, P < 0.02), and less family history of DM (36.35 vs. 48.47 %, P < 0.02) as compared to those with FPG ≥126 mg/dL. The sensitivity of diagnosis of DM was only 41.37 % for FPG criterion, while it was 66.53 % for 2hPG criterion. Thus, compared to 2hPG criterion, FPG criterion had a lower sensitivity detecting new cases of DM. The use of FPG criterion would more likely result in underdiagnosing DM, especially in female and less obese subjects, as compared to the use of 2hPG criterion.

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Abbreviations

FPG:

Fasting plasma glucose

2hPG:

2-h post-challenged plasma glucose

OGTT:

Oral glucose tolerance test

NHANES:

National Health and Nutrition Examination Survey

BMI:

Body mass index

ROC:

Receiver operating characteristic

IFG:

Isolated impaired fasting glucose

IGT:

Isolated impaired glucose tolerance

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Acknowledgments

We are in debt to Karen Ramos for excellent logistic and administrative support of this research endeavor.

Conflict of interest

All authors declare that they have no competing interests; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.

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Authors and Affiliations

  1. Department of Clinical Diabetes, Endocrinology, and Metabolism, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, USA

    Jean Huang, Raynald Samoa, Ken C. Chiu & Wei Feng

  2. Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA

    Jean Huang, Raynald Samoa, Ken C. Chiu & Wei Feng

  3. Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan

    Horng-Yih Ou

  4. Division of Endocrinology, Department of Medicine, University of Kansas Medical Center, Kansas City, KS, USA

    Rudruidee Karnchanasorn

  5. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Lee-Ming Chuang

  6. Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

    Lee-Ming Chuang

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  1. Jean Huang
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  3. Rudruidee Karnchanasorn
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Correspondence to Ken C. Chiu or Wei Feng.

Additional information

Ken C. Chiu and Wei Feng contributed equally to this work.

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Huang, J., Ou, HY., Karnchanasorn, R. et al. Clinical implication of fasting and post-challenged plasma glucose in diagnosis of diabetes mellitus. Endocrine 48, 511–518 (2015). https://doi.org/10.1007/s12020-014-0301-3

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  • DOI: https://doi.org/10.1007/s12020-014-0301-3

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