Optimal glycemic control in type 2 diabetes mellitus: fasting and postprandial glucose in context.
Type 2 diabetes mellitus is the consequence of both insulin resistance and impaired insulin secretion. In the progression from normal glucose tolerance to diabetes, postprandial glucose (PPG) levels often rise before fasting plasma glucose (FPG) levels increase above 126 mg/dL (7.0 mmol/L). Numerous epidemiologic studies have shown that impaired glucose tolerance is associated with increased risk for macrovascular disease and that isolated postchallenge hyperglycemia is an independent factor for increased mortality. Reducing the risk for microvascular complications by improving glycosylated hemoglobin (HbA(1c)) levels is well documented. Emerging data now support the relationship between glycemic control and macrovascular disease. Epidemiologic studies documenting postprandial hyperglycemia and the risk for increased mortality suggest that lowering PPG levels might be beneficial. Optimizing both FPG and PPG is important in achieving normal/near-normal glucose levels. Many patients with type 2 diabetes have difficulty attaining the recommended HbA(1c) goal despite normal/near-normal FPG levels; thus, pharmacologic treatment targeting PPG levels may prove beneficial.
Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA. Martin.Abrahamson@joslin.harvard.edu
Martin J
MJ
Abrahamson
D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring; D002219:Carbamates / Q000494:pharmacology / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy* / Q000517:prevention & control; D003925:Diabetic Angiopathies / Q000517:prevention & control; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005905:Glyburide / Q000494:pharmacology / Q000627:therapeutic use; D006442:Glycated Hemoglobin / Q000032:analysis; D065089:Glycoside Hydrolase Inhibitors; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use; D008687:Metformin / Q000494:pharmacology / Q000627:therapeutic use; D010880:Piperidines / Q000494:pharmacology / Q000627:therapeutic use; D019518:Postprandial Period
D000959:Antihypertensive Agents; D001786:Blood Glucose; D002219:Carbamates; D005905:Glyburide; D006442:Glycated Hemoglobin; D065089:Glycoside Hydrolase Inhibitors; D007004:Hypoglycemic Agents; D008687:Metformin; D010880:Piperidines; C417231:Glucovance; C072379:repaglinide