Impact of fasting and postprandial glycemia on overall glycemic control in type 2 diabetes -: Importance of postprandial glycemia to achieve target HbA1c levels

Objective: HbAlc values reflect overall glycemic exposure over the past 2-3 months and are determined by both fasting (FPG) and postprandial plasma glucose (PPG) levels. Cross-sectional studies suggest that attainment of HbAlc goals requires specific targeting of postprandial hyperglycemia. Research design and methods: We undertook a prospective intervention trial to assess the relative contribution of controlling FPG and PPG for achieving recommended HbAlc goals. One hundred and sixty-four patients (90 male and 74 female) with unsatisfactory glycemic control (HbAlc >= 7.5%) were enrolled in an individualized forced titration intensified treatment program. Results: After 3 months HbAlc levels decreased from 8.7 +/- 0.1 to 6.5 +/- 0.1% (p < 0.001); FPG decreased from 174 4 to 117 +/- 2 mg/dl (p < 0.001); PPG decreased from 224 +/- 4 to 159 +/- 3 mg/dl (p < 0.001) and daylong hyperglycemia (average of premeal, postprandial and bedtime plasma glucose excluding FPG) decreased from 199 +/- 4 to 141 +/- 2 mg/dl (p < 0.0001). Patients' weight remained unchanged (84.0 +/- 1.4 kg versus 82.9 +/- 1.5 kg, p = 0.36). No severe hypoglycemia occurred. Only 64% of patients achieving FPG targets of < 100 mg/dl achieved an HbAlc target of <7% whereas 94% of patients achieving the postprandial target of <140 mg/dl did. Decreases in PPG accounted for nearly twice as much for the decreases in HbAlc as did decreases in FPG. PPG accounted similar to 80% of HbAlc when HbAlc was <6.2% and only about 40% when HbAlc was above 9.0%. Conclusions: Control of fasting hyperglycemia is necessary but usually insufficient for achieving HbAlc goals <7%. Control of postprandial hyperglycemia is essential for achieving recommended HbAlc goals. (C) 2006 Elsevier Ireland Ltd. All rights reserved.