The diagnosis of diabetes mellitus. A contest between 3 points!

A major debate is currently taking place on the world diabetes scene on the merits of fasting versus 2-hour postprandial glucose concentrations as a reference point for the diagnosis of diabetes. Other time points of the oral glucose tolerance test on the other hand, seem to attract little attention. In Saudi Arabia however, we have been intrigued by the scale and severity of hyperglycemia observed at one-hour following glucose load. Plasma glucose concentration one-hour postprandially is strikingly abnormal amongst native Saudis and interestingly, is associated with insulin resistance and features of syndrome X. Such observations have prompted us to call into question the wisdom of current practices, namely of excluding the one-hour plasma glucose concentration in the diagnosis of diabetes. In the proceeding article therefore, we describe in detail our local observations and debate the wider scientific and historical issues surrounding the place of one-hour glucose concentration as a potentially useful diagnostic point in the detection and classification of glucose intolerance.