title: Basal Glucose Can Be Controlled, but the Prandial Problem Persists-It's the Next Target!
abstract: Both basal and postprandial elevations contribute to the hyperglycemic exposure of diabetes, but current therapies are mainly effective in controlling the basal component. Inability to control postprandial hyperglycemia limits success in maintaining overall glycemic control beyond the first 5 to 10 years after diagnosis, and it is also related to the weight gain that is common during insulin therapy. The "prandial problem"-comprising abnormalities of glucose and other metabolites, weight gain, and risk of hypoglycemia-deserves more attention. Several approaches to prandial abnormalities have recently been studied, but the patient populations for which they are best suited and the best ways of using them remain incompletely defined. Encouragingly, several proof-of-concept studies suggest that short-acting glucagon-like peptide 1 agonists or the amylin agonist pramlintide can be very effective in controlling postprandial hyperglycemia in type 2 diabetes in specific settings. This article reviews these topics and proposes that a greater proportion of available resources be directed to basic and clinical research on the prandial problem.
authors.affiliation: Division of Endocrinology, Diabetes & Clinical Nutrition, Oregon Health & Science University, Portland, OR riddlem@ohsu.edu.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Riddle
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D052216:Glucagon-Like Peptide 1 / Q000819:agonists / Q000378:metabolism; D065089:Glycoside Hydrolase Inhibitors / Q000627:therapeutic use; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D058228:Islet Amyloid Polypeptide / Q000819:agonists / Q000378:metabolism / Q000627:therapeutic use; D019518:Postprandial Period; D016032:Randomized Controlled Trials as Topic
chemical_list: D001786:Blood Glucose; D065089:Glycoside Hydrolase Inhibitors; D007004:Hypoglycemic Agents; D007328:Insulin; D058228:Islet Amyloid Polypeptide; D052216:Glucagon-Like Peptide 1; C105254:pramlintide