Postprandial Glycemic Control: Achieving Goals in Type 2 Diabetes

Corporate-sponsored Symposium
Supported by an educational grant from Novo Nordisk
Saturday, June 11, 2005
6:00 - 7:30 PM

Panel
Antonio Ceriello, MD
Alan J Garber, MD, PhD
Irl B Hirsch, MD
Lois Jovanovic, MD
Davida Kruger, MSN, APRN-BC, BC-ADM

Moderator
Peter L Salgo, MD

Reported by Joelle Escoffery, PhD

The goal of this panel discussion was to address the role of postprandial glucose control for the prevention of diabetic complications. Strategies for measuring and treating postprandial hyperglycemia were also covered. The recent emphasis on postprandial glycemic control is driven, at least in part, by the recent options to treat postprandial hyperglycemia. Previous emphasis on fasting plasma glucose (FPG) was driven by its ease of measurement. The relationship between fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and A1C is complex. At lower A1C levels, PPG is much more predictive of A1C than FPG. However, at higher A1C levels, FPG becomes more important.

In terms of the relationship between PPG and diabetic complications, epidemiological studies have demonstrated a correlational relationship. There is also some evidence to suggest that treating PPG has an effect on endothelial function. However, conclusive evidence of the relationship between PPG and macrovascular complications is still lacking. Suggestive evidence comes from the Diabetes Control and Complications Trial (DCCT), which demonstrated that patients treated with intensive insulin therapy had a significantly reduced risk of microvascular complications at the same A1C level, compared with their conventionally treated peers. One possible explanation for this finding is that the intensively treated group had better post-prandial control, less glycemic variation, and thus a decreased incidence of diabetic complications.

In terms of the most optimal way to measure PPG, no clear guidelines exist. Although PPG usually peaks approximately an hour after meal consumption, measuring and treating postprandial hyperglycemia an one hour is risky for patients treated with rapid-acting insulin, as insulin will still be on board when testing (and potentially therapy adjustments) is done. Thus, the risk of hypoglycemia is increased. One interesting strategy for postprandial testing discussed by the panel was to use a “7-point testing over 7 days” approach. In this method, patients use the standard 7-point glucose testing approach, but rather than conducting it over the course of a day, they test over the course of a week.