title: Morning hyperglycemic excursions: a constant failure in the metabolic control of non-insulin-using patients with type 2 diabetes.
abstract: OBJECTIVE
  To determine whether, over daytime, one or several hyperglycemic excursions exist that can be general failures in the glycemic control of patients with type 2 diabetes.
  
  
  METHODS
  In 200 non-insulin-using patients with type 2 diabetes, diurnal plasma glucose and insulin profiles were studied. Plasma glucose concentrations were measured after an overnight fast (at 8:00 A.M. immediately before breakfast), during the postprandial period (at 11:00 A.M. and 2:00 P.M.), and during the postabsorptive period (at 5:00 P.M., extended postlunch time).
  
  
  RESULTS
  In the population considered as a whole, prelunch glucose concentrations (12.0 mmol/l) were found to be significantly increased (P < 0.0001) when compared with those observed at 8:00 A.M. (8.8 mmol/l), at 2:00 P.M. (10.5 mmol/l), and at 5:00 P.M. (8.6 mmol/l). Similar significant excursions (P < 0.0001) in prelunch glucose were observed within subsets of patients selected from the following criteria: 1) body weight, 2) HbA(1c), 3) categories of treatment, and 4) residual beta-cell function. From the calculation of areas under the daytime glucose curves, the relative contributions of postprandial and fasting glucose to the total glucose increment were found to be similar.
  
  
  CONCLUSIONS
  High plasma glucose excursions over morning periods seem to be a permanent failure in non-insulin-using patients with type 2 diabetes, whatever the clinical (BMI), biological (HbA(1c)), therapeutic, and pathophysiological (residual beta-cell function) status. Midmorning glucose testing should be recommended for detecting such abnormalities and for correcting them with appropriate therapies.
authors.affiliation: Department of Metabolic Diseases, Lapeyronie Hospital, Montpellier, France. mal-meta-@chu-montpellier.fr
authors.forename: Louis
authors.initials: L
authors.lastname: Monnier
authors.forename: Claude
authors.initials: C
authors.lastname: Colette
authors.forename: Rémy
authors.initials: R
authors.lastname: Rabasa-Lhoret
authors.forename: Hélène
authors.initials: H
authors.lastname: Lapinski
authors.forename: Cécile
authors.initials: C
authors.lastname: Caubel
authors.forename: Antoine
authors.initials: A
authors.lastname: Avignon
authors.forename: Hélène
authors.initials: H
authors.lastname: Boniface
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D002940:Circadian Rhythm / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000453:epidemiology; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period; D017211:Treatment Failure
chemical_list: D001786:Blood Glucose; D007328:Insulin