title: The significance of impaired fasting glucose versus impaired glucose tolerance: importance of insulin secretion and resistance.
abstract: OBJECTIVE
  The American Diabetes Association recommended substituting 2hBS (glycemia at the second hour of an oral glucose tolerance test [OGTT]) for fasting blood glucose (FBS) in screening for glucose intolerance. It is debated whether these tests measure the same abnormality and relate to defective insulin secretion or resistance. This study examines the diagnostic effectiveness of FBS versus 2hBS and their relationship with insulin secretion and resistance.
  
  
  METHODS
  Based on history or physical findings suggesting glucose intolerance, we enrolled 398 unselected subjects admitted to a general Internal Medicine ward. After 5 days of a weight-maintaining diet, FBS, 2hBS, and insulin were measured during OGTT. The homeostatic model assessment was used to assess beta-cell function and insulin resistance.
  
  
  RESULTS
  Excluding 19 patients with diabetes (5%), we identified 284 subjects with normal glucose tolerance (NGT), 22 with isolated impaired fasting glucose (IFG), 59 with isolated impaired glucose tolerance (IGT), and 14 with associated IFG/IGT. The sensitivity of FBS in predicting 2hBS was 19%, specificity 93%. Positive and negative predictive values were 39% and 83%, respectively. Insulin resistance was absent in NGT and IFG and markedly elevated in IGT and IFG/IGT, whereas defective insulin release was significant only in isolated IFG.
  
  
  CONCLUSIONS
  In unselected patients, elevated FBS depends primarily on defective insulin secretion, and impaired 2hBS on insulin resistance. Because these tests measure different alterations, they are useful in combination.
authors.affiliation: Dipartimento di Scienze Mediche (Internal Medicine), Università del Piemonte Orientale A. Avogadro, Novara, Italy.
authors.forename: Gian Piero
authors.initials: GP
authors.lastname: Carnevale Schianca
authors.forename: Antonello
authors.initials: A
authors.lastname: Rossi
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Sainaghi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Maduli
authors.forename: Ettore
authors.initials: E
authors.lastname: Bartoli
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D001824:Body Constitution; D005215:Fasting / Q000502:physiology*; D005260:Female; D018149:Glucose Intolerance / Q000097:blood*; D005951:Glucose Tolerance Test; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D001786:Blood Glucose; D007328:Insulin