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High 1-h glucose in youths with obesity as marker of prediabetes and cardiovascular risk

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Abstract

Purpose

Testing 1-h glucose (1HG) concentration during oral glucose tolerance test is cost-effective to identify individuals at risk of incident type 2 diabetes. Aim of the study was to define 1HG cutoffs diagnostic of incident impaired glucose tolerance (IGT) in youths with obesity, and to evaluate prevalence and association of cutoffs identified in the cohort and from the literature (133 and 155 mg/dl) to cardiovascular disease (CVD) in a population of youths with obesity.

Methods

This is a longitudinal study of 154 youths to identify 1HG cutoffs, and cross-sectional study of 2295 youths to estimate prevalence of high 1HG and association to CVD. Receiver-operating characteristic curves (ROC) were used to establish 1HG cutoffs, and univariate regression analyses to test association of 1HG to blood pressure, lipids and aminotransferases.

Results

ROC analysis identified the 1HG cutoff of 159 mg/dl as having diagnostic accuracy of IGT with area under the ROC 0.82 (95% CI 0.66–0.98), sensitivity 0.86% and specificity 0.79%. In the cross-sectional population, prevalence of high 1HG was 36% and 15% for 133 and 155 mg/dl cutoffs, respectively, and 17% for the 159 mg/dl value. All the examined cutoffs were significantly associated with worse lipid profile, liver function test, reduced insulin sensitivity, secretion and disposition index.

Conclusion

High 1HG is marker of persistent IGT and increased risk of metabolic abnormalities in youths. The 155 mg/dl cutoff is a convenient estimate in young people but longitudinal studies with retinopathy and overt diabetes as end points are advised to verify the 1HG cutoff with the best diagnostic accuracy.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available for reasons related to privacy and participant consent but are available from the corresponding author on reasonable request.

Abbreviations

AUC:

Area under the curve

1 and 2HG:

1 and 2 h glucose

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

BMI:

Body mass index

CVD:

Cardiovascular disease

DBP:

Diastolic blood pressures

FG:

Fasting glucose

HbA1c:

Hemoglobin A1c

HDL-C:

High-density lipoprotein cholesterol

HOMA-IR:

Homeostatic assessment model algorithm of insulin resistance

IFG:

Impaired fasting glucose

IGT:

Impaired glucose tolerance

IGI:

Insulinogenic index

ISI:

Insulin sensitivity index

NGT:

Normal glucose tolerance

OPBG:

“Bambino Gesù” Children’s Hospital

SBP:

Systolic blood pressures

T2D:

Type 2 diabetes

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Funding

The study was supported by grants to Dr Manco by European Commission under the 7th FP_Information Communication Technologies Programme_(MD-Paedigree, Model Driven Paediatric European Digital Repository, GA no 600932); by “Regione Lombardia” “Sviluppare profili genetici di rischio e trasferirli alla Sanità pubblica, in Italia”; Italian Ministry of Health grant RF-OPG-2008-1142374; FPRC 5xmille 2019 and current funds. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Clinical Epidemiology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    L. Ravà

  2. Unit of Endocrinology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    D. Fintini, M. Mariani, A. Deodati, E. Inzaghi, S. Pedicelli, C. Bizzarri & M. Cappa

  3. Department of Systems Medicine, University of Rome ‘Tor Vergata’, Rome, Italy

    S. Cianfarani

  4. Diabetes and Growth Disorders Unit, Bambino Gesù’ Children’s Hospital, IRCCS, Rome, Italy

    S. Cianfarani

  5. Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden

    S. Cianfarani

  6. Research Area for Multifactorial Diseases and Complex Phenotypes, Bambino Gesù Children’s Hospital, IRCCS, Via F. Baldelli 38, 00146, Rome, Italy

    M. Manco

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  1. L. Ravà
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  2. D. Fintini
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Contributions

LR had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: MM. Acquisition, analysis, or interpretation of data: all the authors. Drafting of the manuscript: MM. Critical revision of the manuscript for important intellectual content: all the authors. Statistical analysis: LR. Obtained funding: MC, SC, MM. Supervision: MC, SC, MM.

Corresponding author

Correspondence to M. Manco.

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No disclosures were reported.

Ethical approval

The study was approved by the OPBG Ethics Committee (#2050/2020).

Informed consent

Written informed consent in accordance with the Helsinki declaration was obtained from the child’s parents or legal guardians. Children over age 6 and adolescents provided written absent.

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Ravà, L., Fintini, D., Mariani, M. et al. High 1-h glucose in youths with obesity as marker of prediabetes and cardiovascular risk. J Endocrinol Invest 46, 2555–2562 (2023). https://doi.org/10.1007/s40618-023-02111-6

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  • DOI: https://doi.org/10.1007/s40618-023-02111-6

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