title: Relationship of glycated hemoglobin, and fasting and postprandial hyperglycemia in type 2 diabetes mellitus patients in Malaysia.
abstract: OBJECTIVE
  Studies on the relative contributions of fasting and postprandial hyperglycemia (FH and PPH) to glycated hemoglobin (HbA1c) in patients with type 2 diabetes have yielded inconsistent results. We aimed to assess the relationship by using continuous glucose monitoring in a multi-ethnic cohort.
  
  
  METHODS
  A total of 100 adults with type 2 diabetes were assessed with 6-day continuous glucose monitoring and HbA1c. Area under the curve (AUC) ≥5.6 mmol/L was defined as AUCTOTAL. AUC equal to or greater than each preprandial glucose for 4-h duration was defined as AUCPPH. The total PPH (AUCTPPH) was the sum of the various AUCPPH.The postprandial contribution to overall hyperglycemia was calculated as (AUCTPPH/ AUCTOTAL) × 100%.
  
  
  RESULTS
  The present study comprised of Malay, Indian, and Chinese type 2 diabetes patients at 34, 34 and 28% respectively. Overall, the mean PPH significantly decreased as HbA1cadvanced (mixed model repeated measures adjusted, beta-estimate = -3.0, P = 0.009). Age (P = 0.010) and hypoglycemia (P = 0.006) predicted the contribution difference. In oral antidiabetic drug-treated patients (n = 58), FH contribution increased from 54% (HbA1c6-6.9%) to 67% (HbA1c≥10%). FH predominance was significant in poorly-controlled groups (P = 0.028 at HbA1c9-9.9%; P = 0.015 at HbA1c≥10%). Among insulin users (n = 42), FH predominated when HbA1cwas ≥10% before adjustment for hypoglycemia (P = 0.047), whereas PPH was numerically greater when HbA1cwas <8%.
  
  
  CONCLUSIONS
  FH and PPH contributions were equal in well-controlled Malaysian type 2 diabetes patients in real-world practice. FH predominated when HbA1cwas ≥9 and ≥10% in oral antidiabetic drug- and insulin-treated patients, respectively. A unique observation was the greater PPH contribution when HbA1cwas <8% despite the use of basal and mealtime insulin in this multi-ethnic cohort, which required further validation.
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Lee Ling
authors.identifier: http://orcid.org/0000-0002-6214-6924
authors.initials: LL
authors.lastname: Lim
authors.affiliation: Consultant Biostatistician, Sydney, New South Wales, Australia.
authors.forename: Alan Jm
authors.initials: AJ
authors.lastname: Brnabic
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Siew Pheng
authors.initials: SP
authors.lastname: Chan
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Luqman
authors.initials: L
authors.lastname: Ibrahim
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Sharmila Sunita
authors.initials: SS
authors.lastname: Paramasivam
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Jeyakantha
authors.initials: J
authors.lastname: Ratnasingam
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Shireene Ratna
authors.initials: SR
authors.lastname: Vethakkan
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Alexander Tong Boon
authors.initials: ATB
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000208:ethnology; D005215:Fasting / Q000097:blood*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood*; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D006442:Glycated Hemoglobin
keywords: Continuous glucose monitoring; Fasting hyperglycemia; Postprandial hyperglycemia