The glucose triad and its role in comprehensive glycaemic control: Current status, future management

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Abstract

The prevalence of type 2 diabetes across the world has been described as a global pandemic. Despite significant efforts to limit both the increase in the number of cases and the long-term impact on morbidity and mortality, the total number of people with diabetes is projected to continue to rise and most patients still fail to achieve adequate glycaemic control. Optimal management of type 2 diabetes requires an understanding of the relationships between glycosylated haemoglobin (HbA 1c), fasting plasma glucose and postprandial glucose (the glucose triad), and how these change during development and progression of the disease. Early and sustained control of glycaemia remains important in the management of type 2 diabetes. The contribution of postprandial glucose levels to overall glycaemic control and the role of postprandial glucose targets in disease management are currently debated. However, many patients do not reach HbA 1C targets set according to published guidelines. As recent data suggest, if driving HbA 1C down to lower target levels is not the answer, what other factors involved in glucose homeostasis can or should be targeted? Has the time come to change the treatment paradigm to include awareness of the components of the glucose triad, the existence of glucose variability and their potential influence on the choice of pharmacological treatment? It is becomingly increasingly clear that physicians are likely to have to consider plasma glucose levels both after the overnight fast and after meals as well as the variability of glucose levels, in order to achieve optimal glycaemic control for each patient. When antidiabetic therapy is initiated, physicians may need to consider selection of agents that target both fasting and postprandial hyperglycaemia.

Original languageEnglish
Pages (from-to)1705-1711
Number of pages7
JournalInternational Journal of Clinical Practice
Volume64
Issue number12
DOIs
Publication statusPublished - Nov 2010

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Glucose
Type 2 Diabetes Mellitus
Fasting
Physicians
Glycosylated Hemoglobin A
Pandemics
Disease Management
Hypoglycemic Agents
Hyperglycemia
Meals
Disease Progression
Homeostasis
Therapeutics
Pharmacology
Guidelines
Morbidity
Mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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