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Postprandial Hyperglycemia

  • Chapter
Type 2 Diabetes Mellitus

Part of the book series: Contemporary Endocrinology ((COE))

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summary

In healthy individuals, blood glucose levels in the fasting state are maintained by basal insulin secretion. After a meal, the rise in postprandial glucose (PPG) is controlled by the rapid release of insulin, stimulated by both glucose and the intestinal production of incretin hormones. In diabetic individuals, postprandial insulin secretion is insufficient, resulting in postprandial hyperglycemia (PPHG). Sustained hyperglycemia results in“glucotoxicity,” that results in progressively irreversible ss-cell dysfunction. There is increasing evidence that PPHG exerts a more deleterious effect on endothelial function and the vascular system, than elevation of fasting plasma glucose (FPG). In particular, individuals with normal FPG but impaired glucose tolerance (IGT) have significantly increased risk of cardiovascular events. With the recognition of the importance of PPHG and the availability of new pharmacologic options, management of diabetes will shift to greater attention to PPG levels. Currently, there are many approaches to tackle PPHG; dietary management and promotion of exercise are very effective. In particular, meglitinides, disaccharidase inhibitors, sulfonylureas and short acting insulin analogues are particularly suited to treat PPHG. The development of glucagon-like peptide 1 (GLP-1) agonists such as exendin and dipeptidyl peptidase IV (DPP-IV) inhibitors such as vildagliptin holds great promise as additional agents in achieving stringent control of PPG. There is an urgent need for the conduct of randomized controlled trials with long term follow-up, and these studies ought to be powered to study the effect of a variety of therapeutic agents that modify PPG levels, on multiple morbidity endpoints and mortality, in individuals with prediabetes, T1DM and T2 DM. Until such data is available, routine monitoring of PPG levels with a view to impact diabetic outcomes cannot be recommended.

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  1. Vasudevan A. Raghavan
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  1. Duke University Medical Center Durham, NC, USA

    Mark N. Feinglos MD, CM  & M. Angelyn Bethel MD  & 

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A. Raghavan, V., Garber, A.J. (2008). Postprandial Hyperglycemia. In: Feinglos, M.N., Bethel, M.A. (eds) Type 2 Diabetes Mellitus. Contemporary Endocrinology. Humana Press. https://doi.org/10.1007/978-1-60327-043-4_7

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  • DOI: https://doi.org/10.1007/978-1-60327-043-4_7

  • Publisher Name: Humana Press

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