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A glucose tolerance test is the administration of glucose to determine how quickly it is cleared from the blood and homeostasis is maintained.[1] The test is usually used to test for diabetes, insulin resistance, and sometimes reactive hypoglycemia. The glucose is most often given orally so the common test is technically an oral glucose tolerance test (OGTT). The intravenous glucose tolerance test (IGTT or IVGTT) is rarely used. The test may be performed as part of a panel of tests, such as the comprehensive metabolic panel.

Contents

Preparation and cautions

The patient is instructed not to restrict carbohydrate intake in the days or weeks before the test. The test should not be done during an illness, as results may not reflect the patient's glucose metabolism when healthy. A full adult dose should not be given to a person weighing less than 43 kg (94 lb), or exaggerated glucoses may produce a false positive result.

Procedure for OGTT

The patient should have been fasting for the previous 8-14 hours (water is allowed).

Usually the OGTT is scheduled to begin in the morning (0700-0800) as glucose tolerance exhibits a diurnal rhythm with a significant decrease in the afternoon. A zero time (baseline) blood sample is drawn.

The patient is then given a glucose solution to drink. In the US, dosing is by weight, and since the late 1970s has been 1.75 grams of glucose per kilogram of body weight, to a maximum dose of 75 g. Prior to 1975 a dose of 100 g was often used. The WHO recommendation is for a 75g oral dose in all adults: the dose is adjusted for weight only in children.[2] The dose should be drunk within 5 minutes.

Blood is drawn at intervals for measurement of glucose (blood sugar), and sometimes insulin levels. The intervals and number of samples vary according to the purpose of the test. For simple diabetes screening, the most important sample is the 2 hour sample and the 0 and 2 hour samples may be the only ones collected. In research settings, samples may be taken on many different time schedules.

If renal glycosuria (sugar excreted in the urine despite normal levels in the blood) is suspected, urine samples may also be collected for testing along with the fasting and 2 hour blood tests.

Interpretation of OGTT results

Fasting plasma glucose should be below 6.1 mmol/l (100 mg/dl). Fasting levels between 6.1 and 7.0 mmol/l (100 and 125 mg/dl) are borderline ("impaired fasting glycaemia"), and fasting levels repeatedly at or above 7.0 mmol/l (126 mg/dl) are diagnostic of diabetes.

The 2 hour glucose level should be below 7.8 mmol/l (140 mg/dl). Levels between this and 11.1 mmol/l (200 mg/dl) indicate "impaired glucose tolerance." Glucose levels above 11.1 mmol/l (200 mg/dl) at 2 hours confirms a diagnosis of diabetes.

1999 WHO Diabetes criteria - Interpretation of Oral Glucose Tolerance Test
Glucose levels NORMAL impaired fasting glycaemia (IFG) impaired glucose tolerance (IGT) Diabetes Mellitus (DM)
Venous Plasma Fasting 2hrs Fasting 2hrs Fasting 2hrs Fasting 2hrs
(mmol/l) <6.1 <7.8 > 6.1 & <7.0 <7.8 <7.0 >7.8 >7.0 >11.1
(mg/dl) <100 <140 >100 & <126 <140 <126 >140 >126 >200

Variations

A standard 2 hour OGTT is sufficient to diagnose or exclude all forms of diabetes mellitus at all but the earliest stages of development. Longer tests have been used for a variety of other purposes, such as detecting reactive hypoglycemia or defining subsets of hypothalamic obesity. Insulin levels are sometimes measured to detect insulin resistance or deficiency.

The OGTT is of limited value in the diagnosis of reactive hypoglycemia, since (1) normal levels do not preclude the diagnosis, (2) abnormal levels do not prove that the patient's other symptoms are related to a demonstrated atypical OGTT, and (3) many people without symptoms of reactive hypoglycemia may have the late low glucoses that are said to be characteristic. Using a glucose tolerance in this context resembles use of a Rorschach test in that it is often used to support a diagnosis that the patient and doctor are already reaching agreement on based on other evidence, but it is inadequate by itself to confirm or refute the diagnosis (unlike its use for diabetes).

When the glucose is given intravenously it is termed an intravenous glucose tolerance test (IVGTT) or intravenous glucose challenge test (IVGCT). This has been used in the investigation of early insulin secretion abnormalities in prediabetic states.

See also

References

  1. ^ MeSH Glucose+Tolerance+Test
  2. ^ World Health Organization and International Diabetes Federation (1999). Definition, diagnosis and classification of diabetes mellitus and its complications. Geneva, Switzerland: World Health Organization. 

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