Does postprandial blood glucose matter and why?

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. There is a linear relationship between the risk of cardiovascular (CV) death and the 2-hour oral glucose tolerance test (OGTT), while a recent study confirms postprandial hyperglycemia as independent risk factor for CVD in type 2 diabetes. At the same time, several intervention studies show that treating postprandial hyperglycemia may reduces the incidence of new CV events. Evidence supports the hypothesis postprandial hyperglycemia may favour the appearance of the CV disease trough the generation of an oxidative stress. Furthermore, clinical data suggest that postprandial hyperglycemia is a common phenomenon even in patients who may be considered in “good metabolic control”. Therefore, physicians should consider monitoring and targeting PPG, as well as HbA1c and FPG, in patients with type 2 diabetes. Over the last several years, diabetes organisations around the world have begun to recognise that prandial glucose regulation (PGR) leads to improved outcomes in patients with diabetes. As a result, they have strengthened their recommendations for monitoring and treating postprandial glucose (PPG) (reviewed in reference 1). These recommendations are supported by an increasing body of evidence. Many epidemiological data support this concept, showing that the value of glucose after 2h during an oral glucose tolerance test (OGTT) is an independent risk factor for cardiovascular disease, while fasting glucose is not2-7.Clearly, the OGTT is highly nonphysiological and can not be considered as a meal. However two studies have confirmed that PPG is an independent risk factor for CVD in type 2 diabetes in the clinical setting: “The Diabetes Intervention Study”, which showed that in type 2 diabetics 1h PPG predicts myocardial infarction8, and, more recently, a prospective study, with a mean follow-up of 5 years, able to show that PPG is an independent CVD risk factor, particularly in women, in patients with type 2 diabetes9. Intervention studies are also coming and support the relevance of PPG in the development of CVD. Diabetes mellitus hoy