Taken together, these reports highlight how hyperglycemia—as a whole—is the defining feature of diabetes.
A defect in meal-stimulated insulin secretion, along with resulting postprandial hyperglycemia, is one of the earliest features of type 2 diabetes. However, the treatment of postprandial glucose (PPG) remains controversial, as discussed in the ADA Consensus Statement on Postprandial Glucose.
Fasting glucose levels >95 mg/dL enriched the population of patients with PPG levels in the IGT range, who were selected as eligible participants in the DPP. In this study to examine the possibility of preventing diabetes in at-risk patients, participants had elevated oral glucose tolerance test (OGTT) values but did not have fasting glucose values in the diabetic range.
Data from UKPDS 57 demonstrate that regardless of whether fasting or postprandial glucose is chosen as the target of therapy, optimal glucose control often cannot be achieved without combination therapy with insulin.
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References
Click on the reference to view the abstract online.
American Diabetes Association. Postprandial blood glucose. Diabetes Care. 2001;24:775-778.
Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.
Wright A, Burden ACF, Paisey RB, et al, for the UKPDS Prospective Diabetes Study Group. Sulfonylurea inadequacy: efficacy of addition of insulin over 6 years in patients with type 2 diabetes in the U.K. Prospective Diabetes Study (UKPDS 57). Diabetes Care. 2002;25:330-336.
Three Recently Published Studies
Additional research is needed to clarify the role of postprandial excursions in the development of diabetes-related complications and to determine whether postprandial hyperglycemia should be a specific target of diabetes therapy.
