Abstract | BACKGROUND:
Type 2 diabetes is characterized by a gradual decline in insulin secretion in response to nutrient loads; hence, it is primarily a disorder of postprandial glucose (PPG) regulation. However, physicians continue to rely on fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) to guide management. OBJECTIVES: METHODS: RESULTS: About 33% of people diagnosed as having type 2 diabetes based on postprandial hyperglycemia have normal FPG. PPG contributes > or =70% to the total glycemic load in patients who are fairly well controlled (HbA1c <7.3%). Furthermore, there is a linear relationship between the risk of CV death and the 2-hour oral glucose tolerance test (OGTT). Increased mortality is evident at OGTT levels of approximately 90 mg/dL (5 mmol/L), which is well below current definitions of type 2 diabetes. Biphasic insulin aspart was shown to be more effective at reducing HbA1c below currently recommended levels than basal insulin glargine (66% vs 40%; P < 0.001), and it reduced endothelial dysfunction more effectively than regular insulin (P < 0.01). Repaglinide achieved regression of carotid atherosclerosis (intima-media thickness) in 52% of patients versus 18% for glyburide (P < 0.01) over 1 year, although levels of HbA1c and CV risk factors were similar for both treatment groups. Finally, acarbose reduced the relative risk of CV events by 49% over 3.3 years versus placebo in patients with impaired glucose tolerance (2.2% vs 4.7%; P = 0.03) and by 35% over > or =1 year in patients with type 2 diabetes (9.4% vs 6.1%; P = 0.006). CONCLUSIONS: All components of the glucose triad (ie, FPG, HbA1c, and PPG) should be considered in the management of type 2 diabetes. Therapy targeted at PPG has been shown to improve glucose control and to reduce the progression of atherosclerosis and CV events; therefore, physicians should consider monitoring and targeting PPG, as well as HbA1c and FPG, in patients with type 2 diabetes.
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Authors | Lawrence A Leiter, Antonio Ceriello, Jaime A Davidson, Markolf Hanefeld, Louis Monnier, David R Owens, Naoko Tajima, Jaakko Tuomilehto, International Prandial Glucose Regulation Study Group |
Journal | Clinical therapeutics
(Clin Ther)
Vol. 27 Suppl B
Pg. S42-56
( 2005)
ISSN: 0149-2918 [Print] United States |
PMID | 16519037
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
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Chemical References |
- Biomarkers
- Blood Glucose
- Glycated Hemoglobin A
- Hypoglycemic Agents
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Topics |
- Atherosclerosis
(blood, metabolism)
- Biomarkers
- Blood Glucose
(metabolism)
- Cardiovascular Diseases
(etiology)
- Clinical Trials as Topic
- Diabetes Mellitus, Type 2
(drug therapy, metabolism)
- Diabetic Angiopathies
(complications)
- Glycated Hemoglobin
(metabolism)
- Humans
- Hypoglycemic Agents
(therapeutic use)
- Postprandial Period
(physiology)
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