Accelerated Progression of Two-Hour Plasma Glucose Toward Type 2 Diabetes Above a Threshold Within the Impaired Glucose Tolerance Range: A 10-Year Longitudinal Analysis of the Korean Genome and Epidemiology Study — ASN Events
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Accelerated Progression of Two-Hour Plasma Glucose Toward Type 2 Diabetes Above a Threshold Within the Impaired Glucose Tolerance Range: A 10-Year Longitudinal Analysis of the Korean Genome and Epidemiology Study (#357)

CHANGMIN LEE 1 2 , DOOHWA KIM 1 2 , MYUNGSOO IM 1 2 , JINMI KIM 2 3 , SANGSOO KIM 1 2 4 , JOON HA 5
  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
  2. Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
  3. Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
  4. Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
  5. Department of Mathematics, Howard University, Washington DC, U.S.A.

Individuals with impaired glucose tolerance (IGT) are at high risk of developing type 2 diabetes(1), yet the longitudinal progression of two-hour plasma glucose (2h-PG) within the IGT range has not been well characterized. We investigated whether distinct phases of 2h-PG progression exist before diabetes onset and estimated progression rates and transition times using a 10-year longitudinal cohort. We performed Oral glucose tolerance tests (OGTTs) biennially in participants of the Korean Genome and Epidemiology Study (KoGES; n = 6,144; age 51.3 ± 8.6 years; body mass index 24.4 ± 3.0 kg/m² at baseline) over 10 years (2). We examined 2h-PG distribution among IGT participants. A subgroup progressing sequentially from normal glucose tolerance (NGT) at baseline to prediabetes and subsequently to type 2 diabetes(3) was used to estimate piecewise linear slopes of 2h-PG progression and transition times before and after the identified transition point. Median 2h-PG among IGT participants was 157 mg/dL. The 2h-PG progression rate from 157 to 200 mg/dL was 3.3-fold steeper than 140 to 157 mg/dL (6.52 [95% CI, 6.27–6.77] vs. 1.97 [95% CI, 1.93–2.02] mg/dL/year). The estimated time to progress from 140 to 157 mg/dL was 8.97 years(95% CI, 8.63–9.31), whereas progression from 157 to 200 mg/dL required only 7.09 years(95% CI, 6.85–7.34). Participants of higher 2h-PG range (157–200 mg/dL) exhibited lower insulin sensitivity and β-cell function than the lower IGT range (140–157 mg/dL)(4). Progression of 2h-PG toward type 2 diabetes is not linear, accelerating markedly after approximately 157 mg/dL, a threshold substantially lower than the IGT midpoint (170 mg/dL). This transition point may represent an earlier window for identifying high-risk individuals and implementing preventive interventions before the onset of diabetes.