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March 11, 2010
One Hour Blood Sugar Test is Best Predictor of Future Diabetes Risk
A study just published in the journal Diabetes Care confirms what I have suspected for a long time. The one test that gives the best indication of whether a person is in the process of developing diabetes is not the fasting glucose test used by 99% of family doctors. Nor is it the two hour value found on an oral glucose tolerance test--which has long been the gold standard endorsed by the American Diabetes Association.
What best predicts diabetes in people who are in that middle ground of not normal but not frankly diabetic is the result seen on a blood sugar test taken one hour after a glucose challenge--i.e. after eating a significant amount of carbohydrate.
You can read this study here:
http://care.diabetesjournals.org/content/33/3/557.abstractMinimal Contribution of Fasting Hyperglycemia to the Incidence of Type 2 Diabetes in Subjects With Normal 2-h Plasma Glucose.
Muhammad A. Abdul-Ghani. Diabetes Care March 2010 vol. 33 no. 3 557-561. doi: 10.2337/dc09-1145
In this study the researchers looked at the records of 3,450 subjects who started out with 2-hour plasma glucose concentration <140 mg/dl.[7.7 mmol/L] These subjects were participants in the San Antonio Heart Study (SAHS) and the Botnia Study for 7â€“8 years.
The researchers found that while incidence of type 2 diabetes at follow-up was related to the fasting, 1-h, and 2-h plasma glucose concentrations,
... when the 1-h plasma glucose, but not 2-h plasma glucose, concentration was added to the model, FPG [fasting plasma glucose] concentration was no longer a significant predictor of type 2 diabetes in both studies (NS).
When subjects were matched for the level of 1-h plasma glucose concentration, the incidence of type 2 diabetes markedly increased with the increase in 1-h plasma glucose, but the increase in FPG was not associated with a significant increase in the incidence of type 2 diabetes.
didi wrote:It also seems odd that an increasingly rising fasting number is not indicative of diabetes.
Even the American Association of Clinical Endocrinologists is now recommending that post-meal blood sugars never be allowed to rise above 140 mg/dL. Unfortunately, less informed groups like the ADA havenâ€™t caught up with the science.
The consequences of this are severe. Nerve damage occurs as blood sugar rises above 140 mg/dL. Prolonged exposure to blood sugars above 140 mg/dL causes irreversible beta cell loss (the beta cells produce insulin). 1 in 2 â€śpre-diabeticsâ€ť get retinopathy, a serious diabetic complication. Cancer rates increase as post-meal blood sugars rise above 160 mg/dL. This study showed stroke risk increased by 25% for every 18 mg/dL rise in post-meal blood sugars. Finally, 1-hour OGTT readings above 155 mg/dL correlate strongly with increased CVD risk.
OGTT may be more sensitive than FPG in the evaluation of patients with neuropathy because OGTT is a dynamic measure of peak glycemic control......Specifically, elevated peak serum glucose level may be a more potent pathogen for peripheral nerves than modestly elevated trough glucose levels.
didi wrote:Well if this is true, then I should use the Fuhrman diet rather than the McDougall starch based diet because after eating potatoes, rice, oatmeal etc. My blood sugars often are above 200. I never worried about this but maybe I should. Dr. McDougall in his diabetes video doesn't seem to think these high values and even values much higher are harmful.
I am also wondering about the high blood sugars causing heart damage. Is it possible that it is insulin causing the damage to the heart if eating fat is making you insulin resistant?
I see the word prolonged in Kiki's post. If it goes up to 200 after starches but comes down before the next meal might be different from the sugar staying high even when it is time for the next meal. I like the McDougall way of eating and would hate to change.
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