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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) 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 (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 (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)	<110	<140	>110 & <126	<140	<126	>140	>126	>200

SANDBOX 2

Sindrome di VATER
Malattia rara
Cod. esenz. SSN	RN1250
Classificazione e risorse esterne (EN)
ICD-9-CM	759.81
ICD-10	Q87.2
Sinonimi
Sindrome di VACTERL

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