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What are the best options for controlling prandial glycemia?

Current Diabetes Reports volume 9, pages 355–359 (2009)Cite this article

Abstract

Epidemiologic studies suggest that postprandial hyperglycemia is more strongly linked to an increased risk for cardiovascular events than fasting or preprandial glucose levels. Although the results of prospective randomized studies proving causation of this finding are mixed, clinicians have given increased attention to target therapy to postprandial glucose than in the past. Rapid-acting insulin analogues, glucagon-like peptide-1 agonists, dipeptidyl peptidase-4 inhibitors, and acarbose all target the postprandial glucose levels. This wide range of therapies allows the clinician to mix and match agents of different classes to target the fasting, preprandial, and postprandial glucose to optimize the daily glucose pattern and reduce the risk of diabetic complications.

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References and Recommended Reading

  1. Cavalot F, Petrelli A, Traversa M, et al.: Postprandial blood glucose is a stronger predictor of cardiovascular events than fasting blood glucose in type 2 diabetes mellitus, particularly in women: lessons from the San Luigi Gonzaga Diabetes Study. J Clin Endocrinol Metab 2006, 91:813–819.

    PubMed  Article  CAS  Google Scholar 

  2. Meigs JB, Nathan DM, D’Agostino RB Sr, et al.: Fasting and postchallenge glycemia and cardiovascular disease risk: the Framingham Offspring Study. Diabetes Care 2002, 25:1845–1850.

    PubMed  Article  Google Scholar 

  3. Qiao Q, Tuomilehto J, Borch-Johnsen K: Post-challenge hyperglycaemia is associated with premature death and macrovascular complications. Diabetologia 2003, 46(Suppl 1):M17–M21.

    PubMed  Google Scholar 

  4. Ceriello A, Davidson J, Hanefeld M, et al.: Postprandial hyperglycaemia and cardiovascular complications of diabetes: an update. Nutr Metab Cardiovasc Dis 2006, 16:453–456.

    PubMed  Article  CAS  Google Scholar 

  5. Monnier L, Mas E, Ginet C, et al.: Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA 2006, 295:1681–1687.

    PubMed  Article  CAS  Google Scholar 

  6. Chiasson JL, Josse RG, Gomis R, et al.: Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOPNIDDM trial. JAMA 2003, 290:486–494.

    PubMed  Article  CAS  Google Scholar 

  7. Raz I, Wilson PW, Strojek K, et al.: Effects of prandial versus fasting glycemia on cardiovascular outcomes in type 2 diabetes: the HEART2D trial. Diabetes Care 2009, 32:381–386.

    PubMed  Article  CAS  Google Scholar 

  8. Monnier L, Lapinski H, Colette C: Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients: variations with increasing levels of HbA(1c). Diabetes Care 2003, 26:881–885.

    PubMed  Article  Google Scholar 

  9. Karl DM: The use of bolus insulin and advancing insulin therapy in type 2 diabetes. Curr Diab Rep 2004, 4:352–357.

    PubMed  Article  Google Scholar 

  10. Monnier L, Colette C: Glycemic variability: should we and can we prevent it? Diabetes Care 2008, 31(Suppl 2):S150–S154.

    PubMed  Article  CAS  Google Scholar 

  11. Monnier L, Colette C, Dunseath GJ, Owens DR: The loss of postprandial glycemic control precedes stepwise deterioration of fasting with worsening diabetes. Diabetes Care 2007, 30:263–269.

    PubMed  Article  Google Scholar 

  12. Dimitriadis GD Gerich JE: Importance of timing of preprandial subcutaneous insulin administration in the management of diabetes mellitus. Diabetes Care 1983, 6:374–377.

    PubMed  Article  CAS  Google Scholar 

  13. Raskin P, Allen E, Hollander P, et al.: Initiating insulin therapy in type 2 diabetes: a comparison of biphasic and basal insulin analogs. Diabetes Care 2005, 28:260–265.

    PubMed  Article  CAS  Google Scholar 

  14. Goldfine AB, Mun EC, Devine E, et al.: Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal. J Clin Endocrinol Metab 2007, 92:4678–4685.

    PubMed  Article  CAS  Google Scholar 

  15. Moreira R, Moreira R, Machado N, et al.: Post-prandial hypoglycemia after bariatric surgery: pharmacological treatment with verapamil and acarbose. Obes Surg 2008, 18:1618–1621.

    PubMed  Article  Google Scholar 

  16. Carroll MF, Gutierrez A, Castro M, et al.: Targeting postprandial hyperglycemia: a comparative study of insulinotropic agents in type 2 diabetes. J Clin Endocrinol Metab 2003, 88:5248–5254.

    PubMed  Article  CAS  Google Scholar 

  17. Carroll MF, Izard A, Riboni K, et al.: Control of postprandial hyperglycemia: optimal use of short-acting insulin secretagogues. Diabetes Care 2002, 25:2147–2152.

    PubMed  Article  CAS  Google Scholar 

  18. Manzella D, Grella R, Abbatecola AM, Paolisso G: Repaglinide administration improves brachial reactivity in type 2 diabetic patients. Diabetes Care 2005, 28:366–371.

    PubMed  Article  CAS  Google Scholar 

  19. Derosa G, Mugellini A, Ciccarelli L, et al.: Comparison between repaglinide and glimepiride in patients with type 2 diabetes mellitus: a one-year, randomized, double-blind assessment of metabolic parameters and cardiovascular risk factors. Clin Ther 2003, 25:472–484.

    PubMed  Article  CAS  Google Scholar 

  20. Lovshin JA, Drucker DJ: Incretin-based therapies for type 2 diabetes mellitus. Nat Rev Endocrinol 2009, 5:262–269.

    PubMed  Article  CAS  Google Scholar 

  21. Gilbert MP, Pratley RE: Efficacy and safety of incretin-based therapies in patients with type 2 diabetes mellitus. Am J Med 2009, 122(6 Suppl 1):S11–S24.

    PubMed  Article  Google Scholar 

  22. Heine RJ, Van Gaal LF, Johns D, et al.: Exenatide versus insulin glargine in patients with suboptimally controlled type 2 diabetes: a randomized trial. Ann Intern Med 2005, 143:559–569.

    PubMed  CAS  Google Scholar 

  23. Drucker DJ, Buse JB, Taylor K, et al.: Exenatide once weekly versus twice daily for the treatment of type 2 diabetes: a randomised, open-label, non-inferiority study. Lancet 208, 372:1240–1250.

  24. Aschner P, Kipnes MS, Lunceford JK, et al.: Effect of the dipeptidyl peptidase-4 inhibitor sitagliptin as monotherapy on glycemic control in patients with type 2 diabetes. Diabetes Care 2006, 29:2632–2637.

    PubMed  Article  CAS  Google Scholar 

  25. Dalla Man C, Bock G, Giesler PD, et al.: Dipeptidyl peptidase-4 inhibition by vildagliptin and the effect on insulin secretion and action in response to meal ingestion in type 2 diabetes. Diabetes Care 2009, 32:14–18.

    PubMed  Article  Google Scholar 

  26. Riddle M, Frias J, Zhang B, et al.: Pramlintide improved glycemic control and reduced weight in patients with type 2 diabetes using basal insulin. Diabetes Care 2007, 30:2794–2799.

    PubMed  Article  CAS  Google Scholar 

  27. Lachin JM, Genuth S, Nathan DM, et al.: Effect of glycemic exposure on the risk of microvascular complications in the diabetes control and complications trial—revisited. Diabetes 2008, 57:995–1001.

    PubMed  Article  CAS  Google Scholar 

  28. Blake DR, Meigs JB, Muller DC, et al.: Impaired glucose tolerance, but not impaired fasting glucose, is associated with increased levels of coronary heart disease risk factors. Diabetes 2004, 53:2095–2100.

    PubMed  Article  CAS  Google Scholar 

  29. Gerich JE: Clinical significance, pathogenesis, and management of postprandial hyperglycemia. Arch Intern Med 2003, 163:1306–1316.

    PubMed  Article  CAS  Google Scholar 

  30. Ceriello A, Colagiuri S, Gerich J, Tuomilehto J: Guideline for management of postmeal glucose. Nutr Metab Cardiovasc Dis 2008, 18:S17–S33.

    PubMed  Article  Google Scholar 

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Affiliations

  1. Division of Endocrinology, Georgetown University Hospital, Building D, Room 232, 4000 Reservoir Road NW, Washington, DC, 20007, USA

    Stephen Clement

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  1. Stephen Clement
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Correspondence to Stephen Clement.

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Clement, S. What are the best options for controlling prandial glycemia?. Curr Diab Rep 9, 355–359 (2009). https://doi.org/10.1007/s11892-009-0056-z

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  • DOI: https://doi.org/10.1007/s11892-009-0056-z

Keywords

  • Liraglutide
  • Acarbose
  • Insulin Glargine
  • Exenatide
  • Sitagliptin