Dose–response relationship between the postload–fasting gap and the risk of developing diabetes: a cohort study from multiple centers in China
Authors' conclusion
The postload-fasting gap is an independent and non-linear marker of glycemic risk and remission potential. Incorporating this measure, particularly together with FPG, improves risk stratification and clinical utility, supporting its use as a practical OGTT-derived metric for early identification of people at risk of developing diabetes and targeted prevention.
Study context
- Population
- Adults free of diabetes at baseline, multicentre Chinese cohort, two revisits
- Participants
- 3,094 adults
- Exposure
- Postload–fasting gap, dose–response
- Outcome
- Incident diabetes, incident prediabetes, progression from prediabetes to diabetes, and reversion to normal glucose tolerance (oral glucose tolerance test (OGTT), World Health Organization (WHO) 1999 criteria)
- Follow-up
- Mean 3.24 years
Methodological detailsmulticentre, discrete-time hazard models with restricted cubic splines, cluster bootstrap internal validation
- Multicentre
- Discrete-time hazard models with restricted cubic splines
- Cluster bootstrap internal validation
Main finding
As reported in the abstract
Dose–response of postload–fasting gap with glycaemic outcomes
- Higher gaps associated with higher risks of incident diabetes, incident prediabetes and progression; lower gaps associated with reversion to normal glucose tolerance
- Incident diabetes: risk flat near a gap of 0, increased beyond 2 mmol/L
- Incident prediabetes: risk increased in a generally monotonic fashion; progression: steeper increase; reversion: risk decreased as gap increased
- Robust to alternative covariate sets, knot choices and diagnostic definitions
Observational data: associations, not effects.
Further findings
Prediction of incident diabetes, model F (fasting plasma glucose (FPG) + postload–fasting gap)
- Optimism-corrected AUC
- 0.686
- Continuous net reclassification improvement (up to)
- 0.349
- Integrated discrimination improvement
- 0.005
- Decision curve analysis: higher net benefit for model F across clinically relevant thresholds
- Model F provided the greatest incremental value across outcomes
Original publication
Dose–response relationship between the postload–fasting gap and the risk of developing diabetes: a cohort study from multiple centers in China. BMJ Open Diabetes Res Care. Published 4 December 2025. doi:10.
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