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- May 12, 2008 |
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"Impaired Glucose Tolerance versus Impaired Fasting Glucose: Is the Risk the Same?"Prof. Markolf Hanefeld (biography)
English - 2005-04-14 - 29 minutes
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Summary :
IGT and IFG are two risk categories for type 2 diabetes. According to the NCEPIII definition fasting hyperglycemia but not postchallenge hyperglycemia is considered as a single trait of the metabolic syndrome. As consistently shown IFG and IGT bear a similar risk for subsequent conversion to type 2 diabetes. They are, however, different in underlying pathophysiology: IFG is more related to insulin resistance whereas there is a dominance of early phase insulin secretion deficit in IGT. As we could show with the Risk Factors in IGT for Atherosclerosis and Diabetes (RIAD) study the level of major cardiovascular risk factors and prevalence of traits of the metabolic syndrome is similar in IFG and IGT. But, there is now a bulk of evidence from prospective studies that postprandial or 2 hour postchallenge plasma glucose is a risk factor for cardiovascular disease whereas no significant relationship between cardiovascular events and fasting plasma glucose can be observed in IFG. In the RIAD study IGT but not IFG was associated with intima media thickening (IMT) of the common carotid arteries. Multivariate analysis reveals 2 h postchallenge plasma glucose as independent predictor of IMT within a broad spectrum of coronary risk factors. Recently published data suggest that oxidative stress and low grade inflammation may be links between postprandial glucose excursion, endothelial dysfunction and development of plaques.
By extrapolation IFG and IGT are similar as risk factor for diabetes but IGT is more closely related to cardiovascular risk. IGT therefore should be considered as part of the "glucose trait" of the metabolic syndrome in its own right. Prospective studies of subjects with IGT show that treatment of pp hyperglycemia reduces progression of IMT in a high risk population.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Differences in demographic epidemiology between IFG and IGT
- Differences in underlying pathophysiology between IFG and IGT
- IFG- and IGT-associated risk for diabetes
- Differences in the risk of CVD with IFG or IGT
Bibliographic references :
Markolf Hanefeld, MD, PHD, Carsta Koehler, PHD, Katja Fuecker, DIPL CHEM, Elena Henkel, MD, Frank Schaper, MD and Theodora Temelkova-Kurktschiev, MD, PHD. Insulin Secretion and Insulin Sensitivity Pattern Is Different in Isolated Impaired Glucose Tolerance and Impaired Fasting Glucose - The Risk Factor in Impaired Glucose Tolerance for Atherosclerosis and Diabetes Study Diabetes Care 26:868-874, 2003.
Kohler C, Temelkova-Kurktschiev T, Schaper F, Fucker K, Hanefeld M.
[Prevalence of newly diagnosed type 2 diabetes, impaired glucose tolerance and abnormal fasting glucose in a high risk population. Data from the RIAD study using new diagnostic criteria for diabetes]Dtsch Med Wochenschr. 1999 Sep 17;124(37):1057-61.
TS Temelkova-Kurktschiev, C Koehler, E Henkel, W Leonhardt, K Fuecker and M Hanefeld. Postchallenge plasma glucose and glycemic spikes are more strongly associated with atherosclerosis than fasting glucose or HbA1c levelDiabetes Care. 2000;23(12):1830-1834.
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