The postprandial hyperglycaemia and its role at the development of diabetic complications

Abstract

Actually, the recommended goal of glycemic control in the treatment of diabetes mellitus is to approach normoglycaemia, usually assessed by fasting plasma glucose (FPG) and glycated haemoglobin (HbA_1c). The level of HbA_1c) is a statistical measure and expresses a mean blood glucose concentration in time. It does not provide information on short-term fluctuations of blood glucose. For that reason measurements of fasting blood glucose and HbA_1c as a routine do not reflect the glucose level after a meal. HbA_1c is related to fasting plasma glucose (60–80%) and postprandial plasma glucose (PPG) (20–40%). The elevated PPG contributes to overall glycemic control. Hyperglycaemia is independent risk factor for macro- and microvascular diabetic complications and increased risk of death. Actual WHO and ADA guidelinesrecommend fasting and preprandial glucose concentrations control as well as HbA_1c. The only setting in which PPG monitoring has been shown to improve out-comes is gestational diabetes. There is lack of evidence in clinical trials on contribution of postprandial glucose to the long-term complications of diabetes and comparing PPG versus HbA_1c lowering therapy.