Abstract
Introduction: Obesity, particularly morbid obesity, is associated with significant metabolic alterations such as insulin resistance and compensatory hyperinsulinemia. These pathophysiological changes may influence the performance and interpretation of glycemic diagnostic tools, including the oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c). This study is aimed at comparing the diagnostic profiles of OGTT and HbA1c across BMI categories, with a specific focus on morbid obesity and the potential role of elevated insulin levels in test discrepancies. Materials and Methods: This retrospective study included 1031 patients who were classified into nonobese, obese, and morbidly obese groups based on body mass index (BMI). All participants underwent assessment of glycemic status, lipid profile, and related metabolic parameters. Results: Of the study population, 86.8% were female. Based on BMI classification, 56.5% were obese, 35.8% morbidly obese, and 7.8% nonobese. The prevalence of dysglycemia (prediabetes + diabetes) was 43.1% according to HbA1c and 30.9% according to OGTT. Dysglycemia was significantly more frequent in the morbidly obese group by HbA1c (p < 0.001), while OGTT showed no significant intergroup difference (p = 0.117). The agreement between methods was low (κ = 0.326). HbA1c, insulin, HOMA-IR, CRP, and triglyceride levels increased with BMI. Insulin-related parameters were higher among HbA1c-defined dysglycemic individuals. Discussion: HbA1c may be more sensitive in identifying early metabolic disturbances, particularly during the compensatory phase involving hyperinsulinemia. Elevated insulin levels may attenuate glucose response during OGTT, potentially reducing its diagnostic sensitivity.