Metabolic characteristics of Africans with normal glucose tolerance and elevated 1-hour glucose: insight from the Africans in America study

Sara M Briker, Thomas Hormenu, Christopher W DuBose, Lilian S Mabundo, Stephanie T Chung, Joon Ha, Arthur Sherman, Marshall K Tulloch-Reid, Michael Bergman, Anne E Sumner, Sara M Briker, Thomas Hormenu, Christopher W DuBose, Lilian S Mabundo, Stephanie T Chung, Joon Ha, Arthur Sherman, Marshall K Tulloch-Reid, Michael Bergman, Anne E Sumner

Abstract

Introduction: Risk of insulin resistance, dyslipidemia, diabetes and cardiac death is increased in Asians and Europeans with normal glucose tolerance (NGT) and 1-hour glucose ≥8.6 mmol/L. As African descent populations often have insulin resistance but a normal lipid profile, the implications for Africans with NGT and glucose ≥8.6 mmol/L (NGT-1-hour-high) are unknown.

Objective: We performed oral glucose tolerance tests (OGTTs) in 434 African born-blacks living in Washington, DC (male: 66%, age 38±10 years (mean±SD)) and determined in the NGT group if either glucometabolic or lipid profiles varied according to a 1-hour-glucose threshold of 8.6 mmol/L.

Methods: Glucose tolerance category was defined by OGTT criteria. NGT was subdivided into NGT-1-hour-high (glucose ≥8.6 mmol/L) and NGT-1-hour-normal (glucose <8.6 mmol/L). Second OGTT were performed in 27% (119/434) of participants 10±7 days after the first. Matsuda Index and Oral Disposition Index measured insulin resistance and beta-cell function, respectively. Lipid profiles were obtained. Comparisons were by one-way analysis of variance with Bonferonni corrections for multiple comparisons. Duplicate tests were assessed by к-statistic.

Results: One-hour-glucose ≥8.6 mmol/L occurred in 17% (47/272) with NGT, 72% (97/134) with pre-diabetes and in 96% (27/28) with diabetes. Both insulin resistance and beta-cell function were worse in NGT-1-hour-high than in NGT-1-hour-normal. Dyslipidemia occurred in both the diabetes and pre-diabetes groups but not in either NGT group. One-hour glucose concentration ≥8.6 mmol/L showed substantial agreement for the two OGTTs (к=0.628).

Conclusions: Although dyslipidemia did not occur in either NGT group, insulin resistance and beta-cell compromise were worse in NGT-1 hour-high. Subdividing the NGT group at a 1-hour glucose threshold of 8.6 mmol/L may stratify risk for diabetes in Africans.

Trial registration: ClinicalTrials.gov NCT00001853.

Keywords: African-origin populations; insulin resistance; insulin secretion; oral glucose tolerance test.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Distribution of glucose concentration at 1 hour and 2 hours for the four glucose tolerance categories.Blue circles: NGT-1-hour-normal (n=225); red circles: NGT-1-hour-high (n=47); green circles: pre-diabetes (n=134); dark yellow circles: diabetes (n=28). NGT-1-hour-high, normal glucose tolerance occurs with 1-hour glucose ≥8.6 mmol/L; NGT-1-hour-normal, normal glucose tolerance occurs with 1-hour glucose

Figure 2

Glucometabolic parameters according to glucose…

Figure 2

Glucometabolic parameters according to glucose tolerance category. (A) Fasting glucose; (B) 2-hour glucose;…

Figure 2
Glucometabolic parameters according to glucose tolerance category. (A) Fasting glucose; (B) 2-hour glucose; (C) AUC-glucose; (D) Insulin Sensitivity Index (Matsuda Index); (E) insulin secretion; (F) Oral Disposition Index. Data adjusted for age and African region of origin and presented as mean±SE. The NGT-1-hour-high group is the comparison group. *p≤0.05,**p≤0.01, ***p≤0.001. AUC-glucose; area under the glucose curve; DM, diabetes mellitus; NGT-1-hour-high, normal glucose tolerance occurs with 1-hour glucose ≥8.6 mmol/L; NGT-1-hour-nl, normal glucose tolerance occurs with 1-hour glucose

Figure 3

Bland-Altman plot for agreement between…

Figure 3

Bland-Altman plot for agreement between glucose concentrations obtained from OGTT-1 and OGTT-2. The…

Figure 3
Bland-Altman plot for agreement between glucose concentrations obtained from OGTT-1 and OGTT-2. The x-axis presents the mean and the y-axis presents the difference of the two determinations. (A) Baseline, bias=−0.72, Pittman’s test: r=−0.38, p
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References
    1. IDF IDF diabetes atlas. 8th edn, 2017. http://www.diabetesatlas.org
    1. Nielsen ML, Pareek M, Leósdóttir M, et al. . One-Hour glucose value as a long-term predictor of cardiovascular morbidity and mortality: the Malmö preventive project. Eur J Endocrinol 2018;41:225–36. 10.1530/EJE-17-0824 - DOI - PubMed
    1. Paddock E, Hohenadel MG, Piaggi P, et al. . One-Hour and two-hour postload plasma glucose concentrations are comparable predictors of type 2 diabetes mellitus in southwestern native Americans. Diabetologia 2017;60:1704–11. 10.1007/s00125-017-4332-1 - DOI - PMC - PubMed
    1. Pareek M, Bhatt DL, Nielsen ML, et al. . Enhanced predictive capability of a 1-hour oral glucose tolerance test: a prospective population-based cohort study. Diabetes Care 2018;41:171–7. 10.2337/dc17-1351 - DOI - PubMed
    1. Andreozzi F, Mannino GC, Perticone M, et al. . Elevated 1-H post-load plasma glucose levels in subjects with normal glucose tolerance are associated with a pro-atherogenic lipid profile. Atherosclerosis 2017;256:15–20. 10.1016/j.atherosclerosis.2016.11.020 - DOI - PubMed
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Figure 2
Figure 2
Glucometabolic parameters according to glucose tolerance category. (A) Fasting glucose; (B) 2-hour glucose; (C) AUC-glucose; (D) Insulin Sensitivity Index (Matsuda Index); (E) insulin secretion; (F) Oral Disposition Index. Data adjusted for age and African region of origin and presented as mean±SE. The NGT-1-hour-high group is the comparison group. *p≤0.05,**p≤0.01, ***p≤0.001. AUC-glucose; area under the glucose curve; DM, diabetes mellitus; NGT-1-hour-high, normal glucose tolerance occurs with 1-hour glucose ≥8.6 mmol/L; NGT-1-hour-nl, normal glucose tolerance occurs with 1-hour glucose

Figure 3

Bland-Altman plot for agreement between…

Figure 3

Bland-Altman plot for agreement between glucose concentrations obtained from OGTT-1 and OGTT-2. The…

Figure 3
Bland-Altman plot for agreement between glucose concentrations obtained from OGTT-1 and OGTT-2. The x-axis presents the mean and the y-axis presents the difference of the two determinations. (A) Baseline, bias=−0.72, Pittman’s test: r=−0.38, p
Similar articles
Cited by
References
    1. IDF IDF diabetes atlas. 8th edn, 2017. http://www.diabetesatlas.org
    1. Nielsen ML, Pareek M, Leósdóttir M, et al. . One-Hour glucose value as a long-term predictor of cardiovascular morbidity and mortality: the Malmö preventive project. Eur J Endocrinol 2018;41:225–36. 10.1530/EJE-17-0824 - DOI - PubMed
    1. Paddock E, Hohenadel MG, Piaggi P, et al. . One-Hour and two-hour postload plasma glucose concentrations are comparable predictors of type 2 diabetes mellitus in southwestern native Americans. Diabetologia 2017;60:1704–11. 10.1007/s00125-017-4332-1 - DOI - PMC - PubMed
    1. Pareek M, Bhatt DL, Nielsen ML, et al. . Enhanced predictive capability of a 1-hour oral glucose tolerance test: a prospective population-based cohort study. Diabetes Care 2018;41:171–7. 10.2337/dc17-1351 - DOI - PubMed
    1. Andreozzi F, Mannino GC, Perticone M, et al. . Elevated 1-H post-load plasma glucose levels in subjects with normal glucose tolerance are associated with a pro-atherogenic lipid profile. Atherosclerosis 2017;256:15–20. 10.1016/j.atherosclerosis.2016.11.020 - DOI - PubMed
Show all 43 references
Publication types
MeSH terms
Associated data
Full text links [x]
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Figure 3
Figure 3
Bland-Altman plot for agreement between glucose concentrations obtained from OGTT-1 and OGTT-2. The x-axis presents the mean and the y-axis presents the difference of the two determinations. (A) Baseline, bias=−0.72, Pittman’s test: r=−0.38, p

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