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JCOM Abstract

J Clin Outcomes Manage 
2005 Feb;12(2):83-87
Utility of 2-hour postchallenge glucose in predicting incident diabetes in older adults with normal fasting glucose: 9-year follow-up of the cardiovascular health study
Shaffer DN, Smith NL, Barzilary JI, Savage PJ, Kuller L, Burke GL

Abstract Objective: To describe the value of measuring 2-hour postchallenge glucose (2HG) levels for predicting the development of diabetes mellitus (DM) among adults aged 65 years and older with normal fasting glucose (FG). Design: Prospective cohort study with baseline and annual clinic visits. Setting and participants: 2213 participants with normal FG (< 100 mg/dL) at baseline from 4 communities throughout the United States comprising the Cardiovascular Health Study. Measurements: New-onset DM was defined as a FG level of 126 mg/dL or higher or starting DM medication. We calculated DM incidence rates during 9 years of follow-up overall and stratified by baseline 2HG level (< 140, 140199, and ? 200 mg/dL). Results: Thirty-six participants (1.6%) developed DM during a mean follow-up of 7.7 years (overall crude incidence rate of 2.1 cases per 1000 person-years). DM incidence rates according to baseline 2HG categories were 1.6 (< 140 mg/dL), 2.3 (140199 mg/dL), and 9.8 (? 200 mg/dL) per 1000 person-years. After adjusting for age, sex, and race, individuals with baseline 2HG of 200 mg/dL or higher were 7 times more likely to develop DM compared with those with baseline 2HG below 140 mg/dL (hazard ratio [HR], 7.0 [95% confidence interval {CI}, 2.916.9]). These risks changed little after adjusting for FG and body mass index (HR, 6.3 [95% CI, 2.615.4]). Among those with baseline 2HG of 200 mg/dL or higher, all new DM cases occurred among participants with at least 1 traditional DM risk factor. Conclusion: Although 2HG is predictive of DM, the overall rate of DM in older adults with normal FG is low.

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