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Morning hyperglycemic excursions. A constant failure in the metabolic control of non-insulin-using patients with type 2 diabetes
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Abstract
MATERIAL AND METHODS. In 200 non-insulin-using patients with type 2 diabetes, diurnal plasma glucose and insulin profiles were studied. Plasma glucose concentrations were measured after an overnight fast (at 8:00 A.M. immediately before breakfast), during the postprandial period (at 11:00 A.M. and 2:00 P.M.), and during the postabsorptive period (at 5:00 P.M., extended postlunch time).
RESULTS. In the population considered as a whole, prelunch glucose concentrations (12.0 mmol/l) were found to be significantly increased (P < 0.0001) when compared with those observed at 8:00 A.M. (8.8 mmol/l), at 2:00 P.M. (10.5 mmol/l), and at 5:00 P.M. (8.6 mmol/l). Similar significant excursions (P < < 0.0001) in prelunch glucose were observed within subsets of patients selected from the following criteria: 1) body weight; 2) HbA1c; 3) categories of treatment and 4) residual β-cell function. From the calculation of areas under the daytime glucose curves, the relative contributions of postprandial and fasting glucose to the total glucose increment were found to be similar.
CONCLUSIONS. High plasma glucose excursions over morning periods seem to be a permanent failure in non–insulin-using patients with type 2 diabetes, whatever the clinical (BMI), biological (HbA1c), therapeutic, and pathophysiological (residual β-cell function) status. Midmorning glucose testing should be recommended for detecting such abnormalities and for correcting them with appropriate therapies.
Abstract
MATERIAL AND METHODS. In 200 non-insulin-using patients with type 2 diabetes, diurnal plasma glucose and insulin profiles were studied. Plasma glucose concentrations were measured after an overnight fast (at 8:00 A.M. immediately before breakfast), during the postprandial period (at 11:00 A.M. and 2:00 P.M.), and during the postabsorptive period (at 5:00 P.M., extended postlunch time).
RESULTS. In the population considered as a whole, prelunch glucose concentrations (12.0 mmol/l) were found to be significantly increased (P < 0.0001) when compared with those observed at 8:00 A.M. (8.8 mmol/l), at 2:00 P.M. (10.5 mmol/l), and at 5:00 P.M. (8.6 mmol/l). Similar significant excursions (P < < 0.0001) in prelunch glucose were observed within subsets of patients selected from the following criteria: 1) body weight; 2) HbA1c; 3) categories of treatment and 4) residual β-cell function. From the calculation of areas under the daytime glucose curves, the relative contributions of postprandial and fasting glucose to the total glucose increment were found to be similar.
CONCLUSIONS. High plasma glucose excursions over morning periods seem to be a permanent failure in non–insulin-using patients with type 2 diabetes, whatever the clinical (BMI), biological (HbA1c), therapeutic, and pathophysiological (residual β-cell function) status. Midmorning glucose testing should be recommended for detecting such abnormalities and for correcting them with appropriate therapies.
Keywords
HbA1c; glycemic control; type 2 diabetes morning hyperglycemic excursions
About this articleTitle
Morning hyperglycemic excursions. A constant failure in the metabolic control of non-insulin-using patients with type 2 diabetes
Journal
Issue
Vol 3, No 2 (2002): Practical Diabetology
Article type
Other materials agreed with the Editors
Pages
95-102
Published online
2002-05-13
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731
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3297
Bibliographic record
Diabetologia Praktyczna 2002;3(2):95-102.
Keywords
HbA1c
glycemic control
type 2 diabetes morning hyperglycemic excursions
Authors
Louis Monnier
Claude Colette
Rémy Rabasa-Lhoret
Hélne Lapinski
Cécile Caubel
Antoine Avignon
Hélne Boniface