Postprandial Hyperglycemia Occurs Very Frequently in Type 2 ...

Post-prandial Hyperglycemia
Occurs Very Frequently in Type 2
Diabetes and Is Related to
Simple Clinical Features
Enzo Bonora, MD, PhD
Endocrinology and Metabolic Diseases
University of Verona, Italy
on behalf of the participants to the Star Project

Introduction
‣ Post-prandial hyperglicemia significantly
contributes to HbA1c concentrations
‣ Post-prandial hyperglicemia significantly
contributes to the development of CVD and
other chronic complications of diabetes
‣ A specific target for post-prandial glycemia has
been indicated by several scientific societies
and expert panels

Aim of the Study
‣ To establish how often post-prandial
hyperglycemia does occur in type 2
diabetes
‣ To identify which clinical features are
associated to post-prandial hyperglycemia
and might predict it

Subjects
6009 type 2 diabetic patients
500 diabetes clinics in Italy
No insulin treatment
Stable diet, physical activity and treatment
No recent acute illness or major co-morbidity
Home blood glucose monitoring: 3 daily
glucose profiles including readings before and
2 h after the 3 meals
3284 patients provided complete data:
18 readings, 9 meals monitored

Methods
‣ HBGM (Euroflash, Lifescan)
‣ HbA1c (DCCT calibrated)
‣ Plasma lipids
‣ BMI
‣ Blood pressure
‣ Treatment
Post-prandial hyperglycemia = >160 mg/dl
Post-prandial peak =
∆≥ 40 mg/dl
∆ % ≥ 25

Main Clinical Features
Male sex (%)
Age (yr)
BMI (kg/m 2 )
Duration (yr)
Fasting glucose (mg/dl)
HbA1c (%)
Total cholesterol (mg/dl)
HDL-cholesterol (mg/dl)
Triglycerides (mg/dl)
Systolic blood pressure (mmHg)
Diastolic blood pressure (mmHg)
Oral agents (%)
51
63 ± 10
28.7 ± 4.6
8.4 ± 7.6
155 ± 44
7.47 ± 1.45
204 ± 38
47 ± 14
149 ± 64
139 ± 16
81 ± 9
87.3

Mean Daily Blood Glucose Profile
in 3284 Non-Insulin-Treated Patients with T2DM
200
Blood glucose (mg/dl)
150
142
161
137
172
136
172
100
Before After Before After Before After
Breakfast Lunch Dinner

Mean Postprandial Blood Glucose Increase
in 3284 Non-Insulin-Treated Patients with T2DM
35
30
30
25
∆ (mg/dl)
25
20
15
10
∆ (%)
20
15
10
5
5
0
B L D
0
B L D
Absolute increase
Relative increase

Frequency of Postprandial Peaks in T2DM
%
40
35
30
25
20
15
10
5
0
All
HbA1c 40 mg/dl.

Proportion of non-insulin-treated patients with
T2DM with exaggerated glucose levels or
glucose excursions following the meals
60
All HbA1c 160 mg/dl
At least 30% of postprandial
glucose excursions >40 mg/dl

Glucose change after meal according to
preprandial glucose
35
30
p

Glucose change after meal according to
35
age and duration of diabetes
∆ glucose (mg/dl)
30
25
20
15
10
5
P

Glucose change after meal according to
the features of the Metabolic Syndrome
35
30
∆ glucose (mg/dl)
25
20
15
10
P

35
Glucose change after meal according
to diabetes treatment
∆ glucose (mg/dl)
30
25
20
15
10
5
0
Diet Met SU Met+SU Other
Overall
p

Multivariate analysis
Factors independently related to excessive
glucose change after meal:
• pre-prandial glucose (inverse; p

Conclusions
‣ Post-prandiale hyperglycemia is a very
frequent phenomenon in patients with
type 2 diabetes on active treatment
‣ Post-prandiale hyperglycemia does
occur also when the metabolic control is
apparently good
‣ Post-prandial hyperglycemia can be
predicted by simple clinical features (preprandial
glycemia, age, duration of
diabetes, BMI, hypertension, treatment)