Introduction: Prediabetes or intermediate hyperglycemia (IH) represents a critical phase in the trajectory toward type 2 diabetes mellitus (T2DM). Recent evidence from the International Diabetes Federation (IDF) suggests that 1-hour OGTT (1HOGTT) ≥8.6 mmol/L is a more sensitive biomarker for early beta-cell dysfunction, with enhanced detection of IH and future T2DM risk. Conventional screening using hemoglobin A1c (HbA1c) or 2-Hour OGTT (2HOGTT) may delay identification of prediabetes, narrowing the window for early intervention. This study evaluates 1HOGTT as a screening tool for prediabetes among Malaysians. Methodology: This cross-sectional study enrolled adults without prior T2DM or prediabetes. Participants underwent 1HOGTT, 2HOGTT, and HbA1c, classified as per the Malaysian Clinical Practice Guideline for T2DM (6th Edition) and IDF 2024 criteria. Agreement between tests was assessed using McNemar’s test and Cohen’s kappa. Diagnostic accuracy was evaluated via receiver operating characteristic (ROC) curve analysis. Cost-effectiveness was determined using reagent cost only. Results: The majority of the 310 participants were female (71.6%), Malay (87.1%), with average age of 40. The 1HOGTT identified prediabetes in 21.6% (n = 67) compared to 17.1% (n = 53) by HbA1c and 2.6% (n = 8) by 2HOGTT. McNemar’s test confirmed statistically significant discordance between 1HOGTT and 2HOGTT (chi-square = 53.397, p <0.001): 61 participants were prediabetic by 1HOGTT but normal by 2HOGTT, versus only 2 in the reverse direction. No significant discordance was found between 1HOGTT and HbA1c (chi-square = 2.817, p = 0.093). 1HOGTT demonstrated excellent discriminatory ability against 2HOGTT (AUC = 0.908; 95% CI: 0.837–0.978), significantly outperforming HbA1c (AUC = 0.664; CI: 0.462– 0.867; DeLong p = 0.012). In a population-level cost analysis, 1HOGTT achieved lowest cost per prediabetes case detected (RM 5.79) – approximately 8.3 times and 8.1 times more cost-effective than 2HOGTT (RM 48.08) and HbA1c (RM 46.78) respectively. Conclusion 1HOGTT identifies a significant proportion of individuals with prediabetes missed by 2HOGTT and HbA1c. Incorporating 1HOGTT enhances the detection of prediabetes, is cost-effective, and enables timely preventive measures in our population with high diabetes burden.
Glucose Tolerance Test ; Glycated Hemoglobin ; Prediabetic State

Introduction: Beta-blockers are frequently used as adjunctive therapy in hyperthyroidism to manage adrenergic symptoms, yet their potential to precipitate secondary Raynaud’s phenomenon remains under-recognized. This adverse effect is attributed to β2-adrenoceptor blockade, which impairs peripheral vasodilation and promotes reflex vasoconstriction. Nonselective agents such as propranolol carry this particular risk. Case: A 22-year-old female presented with a 6-month history of palpitations, 11 kg weight loss, and fine tremors. There was no personal or family history of autoimmune or connective tissue disease. She denied any malar rash, joint swelling, alopecia, myopathy, oral ulcers, or uveitis. She also denied using any supplements or any herbal or traditional remedies. Examination revealed tachycardia, fine tremors, and Graves’ ophthalmopathy, but no acropachy or organomegaly. Investigations confirmed Graves’ disease: Free T4 of 73 pmol/L, thyroid-stimulating hormone <0.05 mIU/L, with elevated anti-thyroid peroxidase and antithyroglobulin antibodies. Full blood count, renal, and liver function were unremarkable. She was commenced on carbimazole 20 mg daily and propranolol 40 mg three times daily. After 8 months of treatment, she developed cold-induced digital color changes and skin tightening consistently, suggestive of Raynaud’s phenomenon. Dose reduction of propranolol to 20 mg BD only yielded partial improvement. Propranolol was subsequently substituted with verapamil, a nondihydropyridine calcium channel blocker, resulting in significant resolution of Raynaud’s phenomenon. Conclusion Propranolol-induced Raynaud’s phenomenon is an underrecognized complication in the management of Graves’ disease, and this case illustrates that it may develop insidiously after months of therapy and can persist despite dose reduction. Substitution with verapamil achieves rate control without β2-adrenergic antagonism. Clinicians should maintain a low threshold for recognizing this adverse effect and consider early substitution with verapamil in affected patients. While verapamil does not confer the same adrenergic blockade as propranolol, its vasodilatory properties make it a rational and effective alternative in this context.
Raynaud Disease ; Graves Disease