• Internal medicine · Jan 2015

    Significance of oral glucose tolerance tests in non-alcoholic fatty liver disease patients with a fasting plasma glucose level of <126 mg/dL and HbA1c level of ≤ 6.4% in Japan.

    • Naoki Matsumoto, Yasuji Arase, Yusuke Kawamura, Miki Ohmoto-Sekine, Kazuhisa Amakawa, Kyoko Ogawa, Hiroshi Tsuji, Hsieh Shiun Dong, Shigeko Hara, Norio Akuta, Fumitaka Suzuki, Yoshiyuki Suzuki, Kenji Ikeda, Hiromitsu Kumada, and Tetsurou Kobayashi.
    • Department of Health Management Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan.
    • Intern. Med. 2015 Jan 1; 54 (8): 875880875-80.

    ObjectiveThe aim of this study was to clarify the indications for oral glucose tolerance tests (OGTT) in non-alcoholic fatty liver disease (NAFLD) subjects with a HbA1c level of ≤6.4%, fasting plasma glucose (FPG) level of <126 mg/dL and no history of diabetes.PatientsA total of 569 NAFLD subjects underwent 75-g OGTT. The plasma glucose and insulin levels were analyzed periodically for three hours during the OGTT examinations. Impaired fasting glucose (IFG) was defined as a plasma glucose level of ≥100 mg/dL to <126 mg/dL. Diabetes was defined as a two-hour post-load plasma glucose level of ≥200 mg/dL. Elevated insulin resistance was defined as a homeostasis model assessment-insulin resistance (HOMA-IR) of ≥2.5. Insulin secretory insufficiency was defined as an insulinogenic index of <0.4.ResultsThe prevalence of diabetes on the OGTT was 7.7% (44/569) among the NAFLD patients with an HbA1c level of ≤6.4%, FPG level of <126 mg/dL and no history of diabetes. A multivariate analysis showed that diabetes occurred more frequently when the subjects had IFG [odds ratio (OR) 5.13; 95% confidential interval (CI) 3.01-8.76; p<0.001] and an HbA1c level of 5.7-6.4% (OR 5.45; 95% CI 3.33-8.93; p<0.001). Of the NAFLD subjects with both IFG and an HbA1c level of 5.7-6.4%, 22.8% (28/123) exhibited a pattern of diabetes on OGTT. Regarding insulin dynamics, among the NAFLD subjects with both IFG and an HbA1c level of 5.7-6.4%, 25.2% (31/123) had elevated IR alone, 25.2% (31/123) had insulin secretory deficiency alone and 27.6% (34/123) had both elevated insulin resistance and insulin secretory deficiency.ConclusionNAFLD subjects with IFG and an HbA1c level of 5.7-6.4% should undergo OGTT in order to determine whether they have diabetes and/or abnormal insulin dynamics.

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