Ts. Temelkova-kurktschiev et al., Postchallenge plasma glucose and glycemic spikes are more strongly associated with atherosclerosis than fasting glucose or HbA(1c) level, DIABET CARE, 23(12), 2000, pp. 1830-1834
OBJECTIVE - To observe the relationship of fasting plasma glucose (FPG), po
stchallenge plasma glucose CPG) (30, 60, 90, and 120 min during an oral glu
cose tolerance test [OGTT], as well as maximal PG during an OGTT, postchall
enge glucose spikes [PGS], and glucose under the OGTT curve), and HbA(1c) t
o intima-media thickness (IMT) as a marker of atherosclerosis.
RESEARCH DESIGN AND METHODS - OGTT, ultrasound measurement of carotid IMT,
and various atherosclerosis risk factors, such as family history of diabete
s, obesity, and/or hyperlipoproteinemia. but without known diabetes, were a
nalyzed in 582 individuals aged 40-70 years and at risk for type 2 diabetes
.
RESULTS - In univariate analysis, all examined glycemic parameters were sig
nificantly correlated to IMT The 2-h postchallenge plasma glucose showed th
e strongest odds ratio (OR) of 1.88 (1.34-2.63) in relation to abnormal IMT
. AII PG variables, except for 30-min glucose in OGTT, showed a significant
OR, whereas the OR for HbA(1c) and FPG was not significant. In logistic re
gression analysis, 2-h PG was identified as the strongest determinant of IM
T from all glycemic parameters. The 2-h PG and PGS, but not FPG, were assoc
iated with a significant rise of IMT in tertiles of HbA(1c). Glycemic param
eters were strongly related to each other and to many atherosclerosis risk
factors. In multivariate analysis including a variety of atherosclerosis ri
sk factors, 2-h PG was a significant independent determinant of IMT.
CONCLUSIONS - PG and PGS are more strongly associated with carotid IMT than
FPG and HbA(1c) level and modify substantially the risk for atherosclerosi
s, estimated by HbA(1c) alone, in a cohort at risk for diabetes and in the
early diabetes stage.