Time to glucose peak during an oral glucose tolerance test identifies prediabetes risk

Summary Context Morphological characteristics of the glucose curve during an oral glucose tolerance test (OGTT) (time to peak and shape) may reflect different phenotypes of insulin secretion and action, but their ability to predict diabetes risk is uncertain. Objective To compare the ability of time to glucose peak and curve shape to detect prediabetes and β‐cell function. Design and participants In a cross‐sectional evaluation using an OGTT, 145 adults without diabetes (age 42±9 years (mean±SD), range 24‐62 years, BMI 29.2±5.3 kg/m2, range 19.9‐45.2 kg/m2) were characterized by peak (30 minutes vs >30 minutes) and shape (biphasic vs monophasic). Main outcome measures Prediabetes and disposition index (DI)—a marker of β‐cell function. Results Prediabetes was diagnosed in 36% (52/145) of participants. Peak>30 minutes, not monophasic curve, was associated with increased odds of prediabetes (OR: 4.0 vs 1.1; P<.001). Both monophasic curve and peak>30 minutes were associated with lower DI (P≤.01). Time to glucose peak and glucose area under the curves (AUC) were independent predictors of DI (adjR2=0.45, P<.001). Conclusion Glucose peak >30 minutes was a stronger independent indicator of prediabetes and β‐cell function than the monophasic curve. Time to glucose peak may be an important tool that could enhance prediabetes risk stratification.