The importance of postprandial glucose concentration: Lessons learned from diabetes and pregnancy

Pregnancy may be considered as a model for the importance of postprandial hyperglycemia on the risk of complications in diabetic subjects in the non-pregnant state. Although pregnancy is only 9 months, the accelerated growth of the fetus is very sensitive to glucose variability and may be similar to a life time of struggle for survival. The toxicity due to hyperglycemia during pregnancy manifests itself by fetal overgrowth secondary to maternal overnourishment to the fetus. Glucose is the main nutrient that passes to the fetus by facilitated diffusion. Thus, maternal hyperglycemia results in a big baby who is also. sick secondary to fetal hyperinsulinemia and the resultant metabolic aberrancy. In addition if the fetus has inherited the type 2 diabetes gene or genes, then the fetal adiposity tends to be accrual of visceral fat, an abnormal distribution of fat in utero that increases the risk of subsequent type 2 diabetes in the child if the baby survives the insult. Studies have shown that the maternal postprandial glucose concentration is the most important variable associated with fetal overgrowth. The studies that support the importance of maternal postprandial glucose concentrations as the primary risk factor in fetopathy and this discussion suggests that these observations may extrapolate to the non-pregnant person with diabetes and are presented in this review.