Glucose Tolerance and Cardiovascular Mortality: Comparison of Fasting and 2-Hour Diagnostic Criteria
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BACKGROUND: New diagnostic criteria for diabetes based on fasting blood glucose (FBG) level were approved by the American Diabetes Association. The impact of using FBG only has not been evaluated thoroughly. The fasting and the 2-hour glucose (2h-BG) criteria were compared with regard to the prediction of mortality. METHODS: Existing baseline data on glucose level at fasting and 2 hours after a 75-g oral glucose tolerance test from 10 prospective European cohort studies including 15 388 men and 7126 women aged 30 to 89 years, with a median follow-up of 8.8 years, were analyzed. Hazards ratios for death from all causes, cardiovascular disease, coronary heart disease, and stroke were estimated. RESULTS: Multivariate Cox regression analyses showed that the inclusion of FBG did not add significant information on the prediction of 2h-BG alone (P>.10 for various causes), whereas the addition of 2h-BG to FBG criteria significantly improved the prediction (P<.001 for all causes and P<.005 for cardiovascular disease). In a model including FBG and 2h-BG simultaneously, hazards ratios (95% confidence intervals) in subjects with diabetes on 2h-BG were 1.73 (1.45-2.06) for all causes, 1.40 (1.02-1.92) for cardiovascular disease, 1.56 (1.03-2.36) for coronary heart disease, and 1.29 (0.66-2.54) for stroke mortality, compared with the normal 2h-BG group. Compared with the normal FBG group, the corresponding hazards ratios in subjects with diabetes on FBG were 1.21 (1.01-1.44), 1.20 (0.88-1.64), 1.09 (0.71-1.67), and 1.64 (0.88-3.07), respectively. The largest number of excess deaths was observed in subjects who had impaired glucose tolerance but normal FBG levels. CONCLUSION: The 2h-BG is a better predictor of deaths from all causes and cardiovascular disease than is FBG.
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Postprandial glucose peaks are a major contributor to the development of chronic complications of diabetes.
“Data from many studies support the view that postprandial glucose peaks appear to play a major role in the pathogenesis of chronic diabetic complications.”
From Prevalence and correlates of post-prandial hyperglycaemia in a large sample of patients with type 2 diabetes mellitus (2006) · cites this paper as [8]
Complications related to accelerated atherosclerosis are more strongly associated with postprandial glucose peaks than with fasting glucose.
“In particular, complications related to accelerated atherosclerosis seem to be related to post-prandial peaks more strongly than to fasting glucose.”
From Prevalence and correlates of post-prandial hyperglycaemia in a large sample of patients with type 2 diabetes mellitus (2006) · cites this paper as [8]
The dose-response effect of the degree of fasting hyperglycaemia for vascular mortality may be weaker than is the case for postload glucose.
“The dose-response effect of the degree of fasting hyperglycaemia for vascular mortality may be weaker than is the case for postload glucose.”
From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [88]
The DECODE pooling study found IGT to be associated with increased risk of coronary death and total cardiovascular death, independent of the level of FPG, while the converse was not the case.
“The DECODE pooling study of European cohorts found IGT to be associated with increased risk of coronary death and total cardiovascular death, independent of the level of FPG, while the converse was not the case.88”
From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [88]
Recent individual-level evidence from prospective studies suggests that fasting hyperglycaemia, postload glucose, and A1c are all robust predictors of vascular mortality, and multivariable adjusted analyses indicate these associations are independent of vascular risk factors such as obesity, blood pressure, triglyceride and lipoproteins.
“A recent individual-level evidence from prospective studies suggests that fasting hyperglycaemia (figure 3), postload glucose, and A1c are all robust predictors of vascular mortality86,88,89 and, according to multivariable adjusted analyses, these associations are independent of vascular risk factors, such as obesity, blood pressure, triglyceride and lipoproteins.84,85,87”
From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [88]
The two-hour post-load glucose level is more strongly associated with CAD risk than the fasting level in subjects with impaired glucose tolerance.
“The two hours glucose level post glucose load was more strongly associated with the risk for CAD than the fasting level in subjects with IGT147, 148).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [147]
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- Authors
- DECODE Study Group; on behalf of the European Diabetes Epidemiology Group
- Corresponding author
- DECODE Study Group; on behalf of the European Diabetes Epidemiology Group
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2001-02-12
- Volume
- 161
- Issue
- 3
- Pages
- 397
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W1555860740
- Cited by
- 1,371
- References
- 34
- Citations by year
- 2026: 19 · 2025: 25 · 2024: 27 · 2023: 22 · 2022: 31 · 2021: 27 · 2020: 42 · 2019: 39 · 2018: 40 · 2017: 47 · 2016: 53 · 2015: 62 · 2014: 63 · 2013: 73 · 2012: 80
- FWCI
- 33.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- glucose tolerance, fasting blood glucose, 2-hour postprandial glucose, oral glucose tolerance test, diabetes diagnostic criteria, cardiovascular mortality, all-cause mortality, coronary artery disease, stroke, impaired glucose tolerance, risk prediction
- MeSH terms
- Adult, Aged, Aged, 80 and over, Blood Glucose, Cardiovascular Diseases, Coronary Disease, Diabetes Mellitus, Female, Glucose Tolerance Test, Humans, Male, Middle Aged, Predictive Value of Tests, Multivariate Analysis, Proportional Hazards Models, Stroke
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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