Postprandial glucose regulation: New data andnew implications

Lawrence A. Leiter, Antonio Ceriello, Jaime A. Davidson, Markolf Hanefeld, Louis Monnier, David R. Owens, Naoko Tajima, Jaakko Tuomilehto

Research output: Contribution to journalArticle

Abstract

Background: Type 2 diabetes is characterized by agradual decline in insulin secretion in response to nutrient loads; hence, it is primarily a disorder of post-prandial glucose (PPG) regulation. However, physicians continue to rely on fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) to guide management. Objectives: The objectives of this article are to review current data on postprandial hyperglycemia and to assess whether, and how, management of type 2 diabetes should change to reflect new clinical findings. Methods: Articles were selected from MEDLINE searches (key words: postprandial glucose, postprandial hyperglycemia, and cardiovascular disease) and from our personal reference files, with emphasis on the contribution of postprandial hyperglycemia to overall glycemic load or cardiovascular (CV) risk. Results: About 33% of people diagnosed as having type 2 diabetes based on postprandial hyperglycemia have normal FPG. PPG contributes ≥70% to the total glycemic load in patients who are fairly well controlled (HbA,1c ≤.3%). Furthermore, there is a linear relationship between the risk of CV death and the 2-hour oral glucose tolerance test (OGTT). Increased mortality is evident at OGTT levels of ∼90 mg/dL (5 mmol/L), which is well below current definitions of type 2 diabetes. Biphasic insulin aspart was shown to be more effective at reducing HbAlc below currently recommended levels than basal insulin glargine (66% vs 40%; P <0.001), and it reduced endothelial dysfunction more effectively than regular insulin (P <0.01). Repaglinide achieved regression of carotid atherosclerosis (intima-media thickness) in 52% of patients versus 18 % for glyburide (P <0.01) over 1 year, although levels of HbAlc and CV risk factors were similar for both treatment groups. Finally, acarbose reduced the relative risk of CV events by 49% over 3.3 years versus placebo in patients with impaired glucose tolerance (2.2% vs 4.7%; P = 0.03) and by 35% over ≥1 year in patients with type 2 diabetes (9.4% vs 6.1%; P = 0.006). Conclusions: All components of the glucose triad (ie,FPG, HbA1c, and PPG) should be considered in the management of type 2 diabetes. Therapy targeted at PPG has been shown to improve glucose control and to reduce the progression of atherosclerosis and CV events; therefore, physicians should consider monitoring and targeting PPG, as well as HbAlc and FPG, in patients with type 2 diabetes.

Original languageEnglish
JournalClinical Therapeutics
Volume27
Issue numberSUPPL. 2
DOIs
Publication statusPublished - 2006

Fingerprint

Glucose
Type 2 Diabetes Mellitus
Meals
Hyperglycemia
Fasting
repaglinide
Glucose Tolerance Test
Insulin Aspart
Biphasic Insulins
Insulin
Acarbose
Physicians
Carotid Intima-Media Thickness
Carotid Artery Diseases
Glucose Intolerance
Glyburide
Glycosylated Hemoglobin A
MEDLINE
Atherosclerosis
Cardiovascular Diseases

Keywords

  • cardiovascular disease
  • postprandial glucose
  • postprandial hyperglycemia
  • type 2 diabetes

ASJC Scopus subject areas

  • Pharmacology

Cite this

Leiter, L. A., Ceriello, A., Davidson, J. A., Hanefeld, M., Monnier, L., Owens, D. R., ... Tuomilehto, J. (2006). Postprandial glucose regulation: New data andnew implications. Clinical Therapeutics, 27(SUPPL. 2). https://doi.org/10.1016/j.clinthera.2005.11.020

Postprandial glucose regulation : New data andnew implications. / Leiter, Lawrence A.; Ceriello, Antonio; Davidson, Jaime A.; Hanefeld, Markolf; Monnier, Louis; Owens, David R.; Tajima, Naoko; Tuomilehto, Jaakko.

In: Clinical Therapeutics, Vol. 27, No. SUPPL. 2, 2006.

Research output: Contribution to journalArticle

Leiter, LA, Ceriello, A, Davidson, JA, Hanefeld, M, Monnier, L, Owens, DR, Tajima, N & Tuomilehto, J 2006, 'Postprandial glucose regulation: New data andnew implications', Clinical Therapeutics, vol. 27, no. SUPPL. 2. https://doi.org/10.1016/j.clinthera.2005.11.020
Leiter, Lawrence A. ; Ceriello, Antonio ; Davidson, Jaime A. ; Hanefeld, Markolf ; Monnier, Louis ; Owens, David R. ; Tajima, Naoko ; Tuomilehto, Jaakko. / Postprandial glucose regulation : New data andnew implications. In: Clinical Therapeutics. 2006 ; Vol. 27, No. SUPPL. 2.
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