Review of methods for detecting glycemic disorders

Area of Science:

• Endocrinology
• Metabolic Disorders
• Clinical Diagnostics

Background:

• Prediabetes, characterized by impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), increases the risk of type 2 diabetes (T2D) and cardiovascular disease (CVD).
• Accurate and early diagnosis of prediabetes is crucial for timely intervention with lifestyle modifications.
• Current international consensus on diagnosing prediabetes using HbA1c or glucose criteria from the American Diabetes Association (ADA) and World Health Organization (WHO) is lacking, with complexities arising from factors like genetics affecting HbA1c interpretation.

Purpose of the Study:

• To review established and novel methods for detecting glucose disorders, including prediabetes.
• To evaluate the potential of various diagnostic approaches, such as 1-hour plasma glucose (1-h PG), in identifying individuals at risk for T2D and CVD.
• To discuss the need for further research into the comparative efficacy and cost-effectiveness of advanced diagnostic tools versus simpler methods.

Main Methods:

• Review of established glucose and HbA1c parameters for prediabetes detection.
• Exploration of novel diagnostic approaches: 1-hour plasma glucose (1-h PG), glucose challenge test (GCT), glucose curve shape analysis, genetic markers, continuous glucose monitoring (CGM), insulin secretion/sensitivity measures, metabolomics, and ancillary tools (fructosamine, glycated albumin (GA), 1,5-anhydroglucitol (1,5-AG)).
• Assessment of the diagnostic potential and clinical utility of these methods.

Main Results:

• The 1-hour plasma glucose (1-h PG) shows significant potential as a biomarker for detecting glucose disorders.
• Existing diagnostic criteria for prediabetes lack international consensus, leading to varied risk identification.
• Advanced methods like genetics and omics require further investigation to determine their superiority over simpler tools for precise, individualized treatment.

Conclusions:

• The 1-hour plasma glucose (1-h PG) holds promise for prediabetes detection, pending further data and health economic analysis.
• The comparative advantage of 1-hour oral glucose tolerance tests (OGTT) over genetics and omics for personalized treatment needs more research.
• Novel diagnostic tools must demonstrate substantial superiority in accuracy and cost-effectiveness to justify their complexity compared to established methods.