Prandial hyperglycemia: is it important to track and treat?
Prandial hyperglycemia comprises 16 to 18 hours in type 2 diabetes. Depending on quality of diabetes control, 30% to 70% of the variance of hemoglobin A(1c) is determined by postprandial glucose excursions. A large amount of evidence now shows that postprandial/postchallenge glucose value is an independent cardiovascular risk factor, especially for coronary heart disease. Excessive postprandial hyperglycemia initiates a cascade of proatherogenic disturbances, which leads to endothelial dysfunction and plaque instability. Measurement of 2-hour postprandial glucose after big meals should be performed once or twice a week in subjects with type 2 diabetes. Measurement of 2-hour glucose after a 75-g oral glucose tolerance test is the only way to detect subjects with impaired glucose tolerance and isolated postchallenge hyperglycemia in the diagnosis for diabetes. a-Glucosidase inhibitors, glinides, and short-acting analogue insulin allow a well-tailored control of type 2 diabetes with excessive postprandial hyperglycemia. Prospective trials have demonstrated that strict control of postprandial hyperglycemia reduces the incidence of cardiovascular events.
Hanefeld
Markolf
M
Centre of Clinical Studies, GWT-Technical University Dresden, Fiedlerstrasse, Dresden 34 01307, Germany.
Schaper
Frank
F
D001786:Blood Glucose / Q000378:metabolism; D002940:Circadian Rhythm; D003327:Coronary Disease / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D003925:Diabetic Angiopathies / Q000503:physiopathology; D004435:Eating / Q000502:physiology*; D004730:Endothelium, Vascular / Q000503:physiopathology; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006943:Hyperglycemia / Q000097:blood / Q000503:physiopathology*; D008954:Models, Biological; D019518:Postprandial Period
D001786:Blood Glucose; D006442:Glycated Hemoglobin