title: Correlations of fasting and postprandial blood glucose increments to the overall diurnal hyperglycemic status in type 2 diabetic patients: variations with levels of HbA1c.
abstract: Studies from overseas have indicated that postprandial glucose excursions are predominant in subjects with moderate hyperglycemia, while fasting hyperglycemia become the predominant abnormality with worsening of hyperglycemia; however, few studies have yet investigated the correlation between HbA1c and fasting and/or postprandial hyperglycemia in Japanese subjects. We investigated the correlation between fasting and postprandial hyperglycemia and the overall diabetic status, as assessed by measurement of HbA1c, in Japanese patients with type 2 diabetes. Blood glucose (BG) concentrations were determined in the fasting state (8:00 A.M.), during the postprandial phases (at 10:30 A.M., 2:30 P.M. and 8:30 P.M.) and during the postabsorptive periods (at 11:30 A.M. and 17:30 P.M.) in 66 patients with type 2 diabetes who were not being treated with prandial/premixed insulins or alpha-glucosidase inhibitors. The areas under the curve above the fasting BG concentrations (AUC1) and over 110 mg/dl (AUC2) were calculated for further evaluation of the correlations of the postprandial (AUC1) and fasting (AUC2 - AUC1) BG increments to the overall diurnal hyperglycemic status. Subjects were separated into two groups using the HbA1c cutoff value of 8%. The fasting BG was not correlated with the HbA1c in the group with a HbA1c values of less than 8% (r = 0.125, p = 0.473). On the other hand, fasting hyperglycemia was strongly correlated with the HbA1c level in the group with HbA1c values of over 8.0% (r = 0.406, p = 0.023). Furthermore, postprandial hyperglycemia was strongly correlated with the HbA1c in the group with HbA1c levels less than 8.0% (r = 0.524, p = 0.001). Thus, there existed a progressive shift in the contribution of fasting and postprandial hyperglycemia to the overall hyperglycemic status with progression from moderate to severe diabetes mellitus in Japanese type 2 diabetic patients.
authors.affiliation: Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama, Japan. t086028f@yokohama-cu.ac.jp
authors.forename: Kaori
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Uru
authors.initials: U
authors.lastname: Nezu
authors.forename: Jun
authors.initials: J
authors.lastname: Shirakawa
authors.forename: Koichiro
authors.initials: K
authors.lastname: Sato
authors.forename: Yu
authors.initials: Y
authors.lastname: Togashi
authors.forename: Taisuke
authors.initials: T
authors.lastname: Kikuchi
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aoki
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Ito
authors.forename: Mari
authors.initials: M
authors.lastname: Kimura
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Terauchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D044466:Asian People; D001786:Blood Glucose / Q000378:metabolism*; D002940:Circadian Rhythm; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D005215:Fasting; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human