Title:
Glycemic variability in normal glucose regulation subjects with elevated 1-h postload plasma glucose levels.

Abstract:
Subjects with normal glucose regulation (NGR), whose 1-h postload plasma glucose is ≥8.6 mmol/L (155 mg/dL, NGR 1 h ≥ 8.6) during 75-g oral glucose tolerance test (OGTT), have an increased risk of type 2 diabetes and subclinical organ damage. And, the deficiency in islet β cell function is responsible for glycemic disorders. The purpose of this study is to investigate glycemic variability in NGR subjects with elevated 1-h postload plasma glucose levels and its association with islet β cell function. The 29 NGR subjects with 1-h postload plasma glucose ≥8.6 mmol/L (NGR 1 h ≥ 8.6) and 29 age- and sex-matched NGR subjects with 1-h postload plasma glucose <8.6 mmol/L (NGR 1 h < 8.6) were recruited in the study. Insulin sensitivity (Matsuda index, ISI), insulin secretion (insulinogenic index ΔI30/ΔG30), and integrated β cell function measured by the oral disposition index (ΔI30/ΔG30 multiplied by the ISI) were derived from OGTT. All subjects were monitored using the continuous glucose monitoring system for consecutive 72 h. The multiple parameters of glycemic variability included the standard deviation of blood glucose (SDBG), mean blood glucose (MBG), mean of daily differences (MODD), and mean amplitude of glycemic excursions (MAGE). MAGE is considered as a gold standard of glycemic variability. Glycemic variability parameters SDBG, MBG, MODD, and MAGE in NGR 1 h ≥ 8.6 group were higher than those in NGR 1 h < 8.6 group (p < 0.05), and oral disposition index in NGR 1 h ≥ 8.6 group was lower than that in NGR 1 h < 8.6 group (p < 0.05). SDBG, MBG, MODD, MAGE, and 1-h postload plasma glucose all negatively associated with oral disposition index in the separate group (p < 0.05) and in the whole subjects (p < 0.05). After multivariate regression analysis, oral disposition index was the strongest independent contributor to MAGE and 1-h postload plasma glucose in the separate group (p < 0.05) and in the whole subjects (p < 0.05). It is concluded that NGR 1 h ≥ 8.6 group had higher glycemic variability and lower oral disposition index, compared with NGR 1 h < 8.6 group. Increased glycemic variability parameters and elevated 1-h postload plasma glucose consistently associated with declined oral disposition index in subjects from NGR 1 h < 8.6 to NGR 1 h ≥ 8.6 group.