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; Tetsurou Kobayashi

doi:10.2169/internalmedicine.54.3437

ORIGINAL ARTICLES

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, Tetsurou Kobayashi

Author information

Naoki Matsumoto
Department of Health Management Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
Yasuji Arase
Department of Health Management Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
Department of Hepatology, Toranomon Hospital, Japan
Department of Third Internal Medicine (Metabolism), University of Yamanashi, Japan
Yusuke Kawamura
Department of Hepatology, Toranomon Hospital, Japan
Miki Ohmoto-Sekine
Department of Health Management Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
Kazuhisa Amakawa
Department of Health Management Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
Kyoko Ogawa
Department of Health Management Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
Hiroshi Tsuji
Department of Health Management Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
Hsieh Shiun Dong
Department of Health Management Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
Shigeko Hara
Department of Health Management Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
Norio Akuta
Department of Hepatology, Toranomon Hospital, Japan
Fumitaka Suzuki
Department of Hepatology, Toranomon Hospital, Japan
Yoshiyuki Suzuki
Department of Hepatology, Toranomon Hospital, Japan
Kenji Ikeda
Department of Hepatology, Toranomon Hospital, Japan
Hiromitsu Kumada
Department of Hepatology, Toranomon Hospital, Japan
Tetsurou Kobayashi
Department of Third Internal Medicine (Metabolism), University of Yamanashi, Japan

Keywords: non-alcoholic fatty liver disease, oral glucose tolerance test, type 2 diabetes mellitus

JOURNAL OPEN ACCESS

2015 Volume 54 Issue 8 Pages 875-880

DOI https://doi.org/10.2169/internalmedicine.54.3437

Details

Abstract

Objective The 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.
Patients A 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.
Results The 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.
Conclusion NAFLD 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.

Corresponding author

Register with J-STAGE for free!