University of Oulu

Ahuja, V., Aronen, P., Pramodkumar, T. A., Looker, H., Chetrit, A., Bloigu, A. H., Juutilainen, A., Bianchi, C., La Sala, L., Anjana, R. M., Pradeepa, R., Venkatesan, U., Jebarani, S., Baskar, V., Fiorentino, T. V., Timpel, P., DeFronzo, R. A., Ceriello, A., Del Prato, S., … Tuomi, T. (2021). Accuracy of 1-hour plasma glucose during the oral glucose tolerance test in diagnosis of type 2 diabetes in adults: A meta-analysis. Diabetes Care, 44(4), 1062–1069.

Accuracy of 1-hour plasma glucose during the oral glucose tolerance test in diagnosis of type 2 diabetes in adults : a meta-analysis

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Author: Ahuja, Vasudha1; Aronen, Pasi2; Pramodkumar, T. A.3;
Organizations: 1Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
2Biostatistics Unit, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
3Madras Diabetes Research Foundation & Dr. Mohan’s Diabetes Specialties Centre, ICMR Centre for Advanced Research on Diabetes and IDF Centre of Excellence in Diabetes, Chennai, India
4Phoenix Epidemiology and Clinical Research Branch, National Institute for Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
5Unit for Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel
6Center for Life Course Health Research, University of Oulu, Oulu, Finland
7University of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
8Section of Diabetes and Metabolic Diseases, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
9Department of Cardiovascular and Dysmetabolic Diseases, IRCCS MultiMedica, Milan, Italy
10Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
11Department of Medicine III, Technical University of Dresden, Dresden, Germany
12Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
13Healthcare and Social Services of Selänne, Pyhäjärvi, Finland
14Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
15Paul Langerhans Institute of the Helmholtz Zentrum München at the University Hospital Carl Gustav Carus and the Medical Faculty of TU Dresden (PLID), Dresden, Germany
16German Center for Diabetes Research (DZD), Neuherberg, Germany
17Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
18Department of Internal Medicine, Hokuriku Central Hospital, Toyama, Japan
19Lund University Diabetes Centre, Lund University, Malmö, Sweden
20Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
21Department of Public Health, University of Helsinki, Helsinki, Finland
22Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
23Department of Public Health, Clinicum, University of Helsinki, Helsinki, Finland
24Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA
25Division of Endocrinology and Metabolism, Department of Medicine and Department of Population Health, and NYU Langone Diabetes Prevention Program, NYU Grossman School of Medicine, New York, NY
26Abdominal Centre, Endocrinology, Helsinki University Hospital, and Folkhalsan Research Centre, Biomedicum, and Research Program Unit, Clinical and Molecular Medicine, University of Helsinki, Helsinki, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
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Language: English
Published: American Diabetes Association, 2021
Publish Date: 2022-02-28


Objective: One-hour plasma glucose (1-h PG) during the oral glucose tolerance test (OGTT) is an accurate predictor of type 2 diabetes. We performed a meta-analysis to determine the optimum cutoff of 1-h PG for detection of type 2 diabetes using 2-h PG as the gold standard.

Research design and methods: We included 15 studies with 35,551 participants from multiple ethnic groups (53.8% Caucasian) and 2,705 newly detected cases of diabetes based on 2-h PG during OGTT. We excluded cases identified only by elevated fasting plasma glucose and/or HbA1c. We determined the optimal 1-h PG threshold and its accuracy at this cutoff for detection of diabetes (2-h PG ≥11.1 mmol/L) using a mixed linear effects regression model with different weights to sensitivity/specificity (2/3, 1/2, and 1/3).

Results: Three cutoffs of 1-h PG, at 10.6 mmol/L, 11.6 mmol/L, and 12.5 mmol/L, had sensitivities of 0.95, 0.92, and 0.87 and specificities of 0.86, 0.91, and 0.94 at weights 2/3, 1/2, and 1/3, respectively. The cutoff of 11.6 mmol/L (95% CI 10.6, 12.6) had a sensitivity of 0.92 (0.87, 0.95), specificity of 0.91 (0.88, 0.93), area under the curve 0.939 (95% confidence region for sensitivity at a given specificity: 0.904, 0.946), and a positive predictive value of 45%.

Conclusions: The 1-h PG of ≥11.6 mmol/L during OGTT has a good sensitivity and specificity for detecting type 2 diabetes. Prescreening with a diabetes-specific risk calculator to identify high-risk individuals is suggested to decrease the proportion of false-positive cases. Studies including other ethnic groups and assessing complication risk are warranted.

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Series: Diabetes care
ISSN: 0149-5992
ISSN-E: 1935-5548
ISSN-L: 0149-5992
Volume: 44
Issue: 4
Pages: 1062 - 1069
DOI: 10.2337/dc20-1688
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: VA was funded through a grant from the Academy of Finland (grant no 312072). The Botnia studies (LG, TT) have been financially supported by grants from Folkhälsan Research Foundation, the Sigrid Juselius Foundation, The Academy of Finland (grants no. 263401, 267882, 312063 to LG, 312072 to TT), University of Helsinki, Nordic Center of Excellence in Disease Genetics, EU (EXGENESIS, MOSAIC FP7-600914), Ollqvist Foundation, Swedish Cultural Foundation in Finland, Finnish Diabetes Research Foundation, Foundation for Life and Health in Finland, Signe and Ane Gyllenberg Foundation, Finnish Medical Society, Paavo Nurmi Foundation, State Research Funding via the Helsinki University Hospital, Perklén Foundation, Närpes Health Care Foundation and Ahokas Foundation. The study has also been supported by the Ministry of Education in Finland, Municipal Heath Care Center and Hospital in Jakobstad and Health Care Centers in Vasa, Närpes and Korsholm. The Botnia Study has received research funding from Pfizer Inc. and Regeneron Pharmaceuticals. The research leading to these results has received funding from the European Research Council under the European Union's Seventh Framework Programme (FP7/2007-2013) / ERC grant agreement no 269045. TVF was supported by the European Foundation for the Study of Diabetes. DIAPASON study was supported by the Fondazione Romeo ad Enrica Invernizzi – Milano, EFSD/Sanofi programme (to LLS), and Italian Ministry of Health-Ricerca Corrente. The GENFIEV study has been supported by FoRiSID, Rome, Italy and with an unconditional grant from Eli Lilly, Italy. The GOH study was funded by The DCURE Foundation. Oulu45 and Oulu45P studies were funded by the Finnish Cultural Foundation - Central fund. The PIBS study was funded by the Division of Intramural Research of NIDDK, NIH. The PSW and PSWP study were funded by the Japan Health Promotion Foundation and Grant-in-Aid from Toyama Medical Association.
Copyright information: © 2021 by the American Diabetes Association. The final authenticated version is available online at