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: Mediastinal paragangliomas (PGLs) are extremely rare extra-adrenal neuroendocrine tumors, accounting for approximately 2% of all PGLs and commonly associated with pathogenic germline variants (PGVs), particularly those involving succinate dehydrogenase (SDH) mutations. Case: We report a 35-year-old female presenting with chronic cough and hemoptysis, accompanied by paroxysmal symptoms and new-onset hypertension. She had a history of pheochromocytoma treated 15 years earlier with right adrenalectomy and liver lobectomy due to intraoperative adrenal adherence to the liver. Histopathology confirmed adrenal pheochromocytoma, with no evidence of PGL in the liver. She remained in biochemical remission for 3 years but subsequently defaulted. Biochemical evaluation revealed markedly elevated 24-hour urinary normetanephrine (58,950 nmol/L; ~26-fold increase). Computed tomography of the thorax demonstrated a mediastinal mass compressing the right bronchus, resulting in luminal narrowing and segmental lung collapse. Endobronchial biopsy confirmed PGL (Ki-67 index 5%). Functional imaging with DOTATATE, FDG-PET, and MIBG demonstrated metastatic disease involving the lungs and lymph nodes. Genetic testing identified a heterozygous pathogenic SDHB mutation (c.79C>T; p.Arg27), consistent with autosomal dominant hereditary PGL-pheochromocytoma syndrome; family screening confirmed the same mutation in her father and two siblings. She underwent two sessions of bronchoscopic intervention, including cryoablation, balloon dilation, argon plasma coagulation, and intratumoral alcohol injection for airway control and hemoptysis. Multidisciplinary evaluation deemed complete surgical resection high risk and not feasible; therefore, peptide receptor radionuclide therapy was initiated. Conclusion This case demonstrates the aggressive and metastatic nature of SDHB-mutated PGLs. This group of patients require long term surveillance given the risk of developing new tumors even years or decades after primary tumor resection. It highlights the importance of genetic testing following pheochromocytoma surgery to guide targeted therapy, lifelong surveillance, and family screening within a multidisciplinary care approach.
Paraganglioma