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Related Experiment Videos

Oral glucose tolerance test in general practice--when is it worthwhile?

O Rutle1, D Bruusgaard, K Furuseth

  • 1Department of General Practice, University of Oslo, Norway.

Scandinavian Journal of Primary Health Care
|December 1, 1994
PubMed
Summary

An oral glucose tolerance test is crucial for diagnosing impaired glucose tolerance and diabetes across all fasting blood glucose levels from 4.4 to 6.6 mmol/l. No single cutoff point effectively identifies all diabetes cases within this range.

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Area of Science:

  • Endocrinology
  • Diabetes Research
  • Clinical Diagnostics

Background:

  • Fasting blood glucose levels are commonly used as an initial screen for glucose metabolism disorders.
  • The diagnostic accuracy of fasting blood glucose alone for impaired glucose tolerance and diabetes is debated.
  • The World Health Organization (WHO) provides diagnostic criteria for diabetes and impaired glucose tolerance.

Purpose of the Study:

  • To evaluate the probability of detecting impaired glucose tolerance and diabetes using the oral glucose tolerance test (OGTT) at various fasting blood glucose concentrations.
  • To determine the optimal diagnostic threshold for fasting blood glucose in identifying individuals with glucose intolerance or diabetes.

Main Methods:

  • A cohort of 355 patients underwent fasting capillary whole blood glucose measurement.

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  • Patients with fasting blood glucose levels between 4.4 and 6.6 mmol/l were subsequently administered an oral glucose tolerance test.
  • Data were collected from a general practice setting.

    • Main Results:

    • 33% of patients exhibited impaired glucose tolerance, and 12% were diagnosed with diabetes.
    • Diabetes was identified across all tested fasting blood glucose strata.
    • The likelihood of diagnosing diabetes increased significantly with higher fasting blood glucose levels, with a 10-fold increase in the 6.1–6.6 mmol/l stratum compared to the 4.4–4.9 mmol/l stratum.
    • No specific fasting blood glucose cutoff within the 4.4–6.6 mmol/l range demonstrated both high sensitivity and high specificity for diabetes diagnosis.

    Conclusions:

    • To ensure comprehensive detection of impaired glucose tolerance and diabetes, an oral glucose tolerance test is recommended for all individuals within the fasting blood glucose range of 4.4 to 6.6 mmol/l, adhering to WHO criteria.
    • Utilizing a fasting blood glucose cutoff of 5.2 mmol/l for initiating an OGTT maintains high sensitivity (0.95) but may lead to the omission of some diabetes diagnoses.