Glucose tolerance test

Revision as of 00:43, 8 August 2011 by Varun Kumar (talk | contribs)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)
Jump to navigation Jump to search

WikiDoc Resources for Glucose tolerance test

Articles

Most recent articles on Glucose tolerance test

Most cited articles on Glucose tolerance test

Review articles on Glucose tolerance test

Articles on Glucose tolerance test in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Glucose tolerance test

Images of Glucose tolerance test

Photos of Glucose tolerance test

Podcasts & MP3s on Glucose tolerance test

Videos on Glucose tolerance test

Evidence Based Medicine

Cochrane Collaboration on Glucose tolerance test

Bandolier on Glucose tolerance test

TRIP on Glucose tolerance test

Clinical Trials

Ongoing Trials on Glucose tolerance test at Clinical Trials.gov

Trial results on Glucose tolerance test

Clinical Trials on Glucose tolerance test at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Glucose tolerance test

NICE Guidance on Glucose tolerance test

NHS PRODIGY Guidance

FDA on Glucose tolerance test

CDC on Glucose tolerance test

Books

Books on Glucose tolerance test

News

Glucose tolerance test in the news

Be alerted to news on Glucose tolerance test

News trends on Glucose tolerance test

Commentary

Blogs on Glucose tolerance test

Definitions

Definitions of Glucose tolerance test

Patient Resources / Community

Patient resources on Glucose tolerance test

Discussion groups on Glucose tolerance test

Patient Handouts on Glucose tolerance test

Directions to Hospitals Treating Glucose tolerance test

Risk calculators and risk factors for Glucose tolerance test

Healthcare Provider Resources

Symptoms of Glucose tolerance test

Causes & Risk Factors for Glucose tolerance test

Diagnostic studies for Glucose tolerance test

Treatment of Glucose tolerance test

Continuing Medical Education (CME)

CME Programs on Glucose tolerance test

International

Glucose tolerance test en Espanol

Glucose tolerance test en Francais

Business

Glucose tolerance test in the Marketplace

Patents on Glucose tolerance test

Experimental / Informatics

List of terms related to Glucose tolerance test

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A glucose tolerance test in medical practice is the administration of glucose to determine how quickly it is cleared from the blood. 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 test may be performed as part of a panel of tests, such as the comprehensive metabolic panel.

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. The standard dose since the late 1970s has been 1.75 grams of glucose per kilogram of body weight, to a maximum dose of 75 g. It should be drunk within 5 minutes. Prior to 1975 a dose of 100 g was often used.

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), then 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 (110 mg/dl). Fasting levels between 6.1 and 7.0 mmol/l (110 and 126 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 Impaired Glucose Tolerance Diabetes Mellitus
(I.F.G.) (I.G.T.) (D.M.)
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) <110 <140 >110 & <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). This has been used in the investigation of early insulin secretion abnormalities in prediabetic states.


Template:SIB


Template:WH Template:WikiDoc Sources