Yiying Wang, Ram Jagannathan, Cristina Bianchi, Teresa Vanessa Fiorentino, Sang Soo Kim, Jinmi Kim, Soree Ryang, Stefano Del Prato, Giorgio Sesti, Leontine Sandforth, Hubert Preißl, Reiner Jumpertz von Schwartzenberg, Norbert Stefan, Andreas Fritsche, Joon Ha, Andreas L. Birkenfeld, Michael Bergman
Abstract Aims/hypothesis The IDF has proposed 1 h plasma glucose (1 h PG) as a diagnostic test for type 2 diabetes. This study evaluated the utility of 1 h PG in diagnosing type 2 diabetes, compared with fasting plasma glucose (FPG), 2 h plasma glucose (2 h PG), HbA 1c and the combination of HbA 1c plus FPG. Methods Analyses were conducted using data from five independent cohorts: KoGES, CATAMERI, GENFIEV, PLIS (follow-up) and TULIP (follow-up). Type 2 diabetes was defined according to ADA criteria (FPG ≥7.0 mmol/l [≥126 mg/dl], 2 h PG ≥11.1 mmol/l [≥200 mg/dl] or HbA 1c ≥48 mmol/mol [≥6.5%]) or IDF criteria (1 h PG ≥11.6 mmol/l [≥209 mg/dl]). Area under of the receiver operating characteristic curves (AUC-ROCs) were used to assess the performance of 1 h PG relative to FPG and HbA 1c , individually and in combination, for diagnosing diabetes. Random-effects meta-analyses were applied to pooled data to summarise the overall diagnostic accuracy across studies. Results Cohort-specific analyses demonstrated consistently higher AUCs for 1 h PG in KoGES (AUC 0.96 vs 0.88; Δ 0.08; sensitivity 84.2 vs 77.0; specificity 98.6 vs 87.0), CATAMERI (AUC 0.98 vs 0.86; Δ 0.12; sensitivity 75.0 vs 69.4; specificity: 98.4 vs 78.9), GENFIEV (AUC 0.97 vs 0.89; Δ 0.08; sensitivity 89.5 vs 69.4; specificity 100.0 vs 88.3), PLIS follow-up (AUC 0.98 vs 0.76; Δ 0.22; sensitivity 94.9 vs 46.8; specificity 100.0 vs 92.3) and TULIP follow-up (AUC 0.98 vs 0.83; Δ 0.15; sensitivity 90.2 vs 90.2; specificity 100.0 vs 65.0) compared with FPG plus HbA 1c (all p <0.001). Meta-analysis of five cohorts ( N =11,968) revealed superior diagnostic performance of 1 h PG compared with FPG plus HbA 1c , with pooled AUCs (95% CI) of 0.97 (0.96, 0.98) vs 0.85 (0.82, 0.88). Conclusions/interpretation These findings support the superior utility of the IDF-recommended 1 h PG vs FPG, 2 h PG, HbA 1c and FPG plus HbA 1c for diagnosing type 2 diabetes. Graphical Abstract