An evaluation of glycosylated hemoglobin measurement by a colorimetric method as a screening test for gestational diabetes mellitus.

To assess the potential value of glycosylated hemoglobin measurement (HbA1) in screening for gestational diabetes mellitus (GDM), HbA1 by a colorimetric method, plasma glucose level 1 hr after 50 g oral glucose loading, and 3-hr 100 g oral glucose tolerance test (3-hr OGTT) were performed in 334 pregnant women at Ramathibodi Hospital. These subjects carried high risk factors of GDM. Gestational ages varied from 24 to 38 wks. Twenty-four cases were diabetic (7.2%) by O'Sullivan and Mahan's criteria (1964). As a screening test to select subjects for 3-hr OGTT, plasma glucose level 1 hr after 50 g oral glucose load (plasma glucose level 7.8 mmol/L and above) has sensitivity: 87.50 per cent, specificity: 64.19 per cent. HbA1 level of 5.60 per cent (upper 95% confidence limit of the mean) and above yield sensitivity: 66.67 per cent, specificity: 61.29 per cent. Thus, glycosylated hemoglobin measurement as a screening test for GDM is not as effective as the conventional 50 g oral glucose loading test.

Increased insulin secretion in subjects with impaired glucose tolerance.

In order to assess the relative roles of insulin deficiency and insulin resistance in the pathogenesis of impaired glucose tolerance (IGT), simultaneous measurement of serum immunoreactive insulin (IRI) and serum immunoreactive C-peptide (IRC) responses during 75 g oral glucose tolerance test were performed in 44 normal-weight adults with IGT (27 men, mean age +/- SEM = 46.1 +/- 1.9 year; 17 women, aged 49.1 +/- 3.3 year) and 44 control subjects (27 men, aged 45.5 +/- 2.1 year; 17 women, aged 47.9 +/- 3.0 year). Subjects with IGT had consistently higher 120-m IRI levels in comparison to corresponding age, sex, and BMI-matched control subjects, i.e. mean +/- SEM = 118.8 +/- 13.7 vs 57.0 +/- 6.9 microU/ml (male, P = 0.0002), and 116.3 +/- 11.8 vs 43.3 +/- 5.8 microU/ml (female, P = 0.0000). Similarly, 120-m IRC levels were higher in subjects with IGT, i.e. 2.12 +/- 0.26 vs 1.35 +/- 0.15 pmol/ml (male, P = 0.0262), and 3.13 +/- 1.01 vs 1.54 +/- 0.19 pmol/ml (female, P = 0.0080). Our findings indicate that increased insulin secretion is present in subjects with IGT, suggesting that insulin resistance is the predominant factor in the pathogenesis of IGT.

Impaired glucose tolerance in Thai adults: serum insulin profiles after a 75 gram oral glucose load.

Serum immunoreactive insulin (IRI) profiles after ingestion of a 75 g oral glucose load were measured in 150 Thai adults (50 men and 100 women, aged 15-71 years) with impaired glucose tolerance (IGT), and 133 control subjects (49 men and 84 women, aged 19-72 years). There were no significant differences in fasting and 30-minute serum IRI levels between subjects with IGT and corresponding age-, sex-, and body mass index (BMI)-matched controls, while subjects with IGT had consistently higher 120-minute serum IRI levels. Early serum insulin responses, as measured by ratio of increment in serum IRI level to that of plasma glucose level 30 minutes after glucose load (delta IRI 30/delta PG 30), were generally low or normal. However, when subjects with IGT are considered individually, there was marked heterogeneity in serum insulin responses, as judged by 120-minute serum IRI, delta IRI 30/delta PG 30, and ratio of sum of serum IRI levels during oral glucose tolerance test (0, 1/2, and 2 hour) to that of plasma glucose levels (sigma IRI/sigma PG). Most of the cases, i.e. 52, 76.7 and 69.3 per cent using previous criteria respectively, had normal insulin responses. We conclude that, 1) Thai adults with IGT generally have higher 120-minute serum IRI levels compared with corresponding age-, sex-, and BMI-matched controls, 2) early serum insulin responses as measured by delta IRI 30/delta PG 30 are generally low or normal, and 3) there is marked heterogeneity in serum insulin responses among these subjects.