Size and Timing of Postmeal Glucose Peaks in Every Day Life of Type 2 Diabetic Patients. The Capri Experience

Esposito, Katherine; Ceriello, Antonio; Giugliano, Dario
June 2007
Diabetes;Jun2007 Supplement 1, Vol. 56, pA174
Academic Journal
Context: Two-hour postprandial hyperglycemia is related to chronic complications of diabetes and is currently used to describe postmeal glycemic peaks. Objective: To assess size and timing of postmeal glucose peaks in every day life of type 2 diabetic patients, the relationship with carotid atherosclerosis, and the effect of diabetes treatment with insulin secretagogues. Design: The present report focuses on the 644 outpatients with type 2 diabetes attending Diabetes Clinics located in the area of the Campania County, South Italy, who provided complete home blood glucose profiles and centralized carotid intima-media thickness (CIMT) assessment. Moreover, the profiles of postmeal glucose peaks were analyzed using the pooled data of 161 patients who completed a 12-month trial with repaglinide or glyburide. The study was conducted from 2001 to 2005. Main Outcomes Measures: All patients assessed blood glucose at home on 3 nonconsecutive days during one month. Blood glucose was measured just before and every 30 minutes following the main meal of the day for 2 hours. Incremental glucose peak (IG) was the maximal incremental increase in blood glucose obtained at any point following the meal. Patients were divided into 5 groups according to IGP values: 0-50 mg/dL (n=215), 51 - 100 mg/dL (n=180), 101-150 mg/dL (n=87), 151-200 mg/dL (n=67), and >200 mg/dL (n=47). CIMT was assessed by carotid sonography. Results: The level of hemoglobin Ale and CIMT progressively increased from group 1 to group 5 (P for trend =.01 for both). Blood glucose profiles obtained on three different days were highly reproducible (r>0.85); IGP occurred within one hour from the start of the meal in 95% of the entire diabetic population. When CIMT was tested for simple linear correlations against markers of glucose control, the strongest correlation was found with IGP (r=0.40, P=.006). The relation remained significant in multiple linear regression analysis (R² =0.26, P=0.01). In the whole sample, both fasting (r=0.35, P=.01) and 2-hour (r=0.38, P=.01) glucose levels were significantly correlated to hemoglobin A1c. The timing of IGP was not affected by diabetes treatment with insulin secretagogues as it occurred in most patients (92%) within one hour after starting of meal. Conclusions: IGPs are frequent in every day life of type 2 diabetes, occur for the most (95%) within one hour after meal and timing is not influenced by treatment (diet or drugs), and correlate with CIMT. Two-hour glucose level is too late for IGP assessment.



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