Beyond Conventional Glycemic Markers: One-Hour Plasma Glucose in Children and Adolescents

The increasing prevalence of obesity and dysglycemia in children and adolescents has highlighted the limitations of conventional approaches to identifying early disturbances in glucose metabolism. Fasting glucose levels, 2 h plasma glucose (2 h PG) measured during the oral glucose tolerance test (OGTT), and glycated hemoglobin (HbA1c) reflect different aspects of glucose homeostasis and show limited concordance, particularly in the pediatric population. Consequently, a proportion of young individuals at increased metabolic risk may remain classified as having normal glucose tolerance. One-hour plasma glucose (1 h PG), measured as part of the OGTT, has gained attention as a potential indicator of early metabolic deterioration. Evidence from pediatric studies indicates that elevated 1 h PG is associated with lower insulin sensitivity, compromised β-cell function, a reduced disposition index, and an unfavorable cardiometabolic profile, even in children and adolescents exhibiting normal glucose tolerance. Longitudinal data further suggest an association with subsequent progression to prediabetes. However, the optimal pediatric threshold remains uncertain. Although 155 mg/dL (8.6 mmol/L) is the most widely investigated cut-off, with considerable evidence supporting its clinical relevance, lower thresholds around 132.5–133 mg/dL have also been associated with early metabolic abnormalities in youth. Elevated 1 h PG has additionally been linked to vascular alterations, adverse cardiometabolic features, and metabolic dysfunction-associated liver disease, suggesting that its clinical relevance may extend beyond glycemic classification alone. Overall, 1 h PG represents a promising complementary marker for identifying metabolic risk before abnormalities become apparent using conventional criteria. Nevertheless, long-term pediatric data remain limited, and prospective studies across different ages, pubertal stages, and ethnic populations are needed to establish the optimal threshold and clarify its role in routine clinical practice.