News & Research

Abrahamson MJ: Optimal glycemic control in type 2 diabetes mellitus: Fasting and postprandial glucose in context. Arch Intern Med 164:486-491, 2004.

What is the problem and what is known about it so far?

Fasting glucose is a measure of glucose in a person's blood before a meal. Postprandial glucose is the measure of a person's blood glucose after a meal. Glycated hemoglobin (A1C) is a long-term measure of blood glucose control.

Lowering A1C levels reduces the risk of diabetes complications (like heart disease and stroke). But even with medication, some people with type 2 diabetes have trouble lowering their A1C levels. These people may have near-normal fasting glucose levels but high postprandial glucose levels.

The researcher wanted to find out if treating high postprandial glucose levels would help reduce the risk of diabetes complications.

Who was studied?

The researcher looked at a lot of recent studies on controlling high blood glucose (hyperglycemia) in patients with type 2 diabetes.

How was the study done?

The researcher looked at studies that showed the benefits of controlling both fasting and postprandial glucose. He looked at how well diabetes medications lowered postprandial glucose alone, postprandial and fasting glucose together, and A1C.

What did the researchers find?

Oral Drugs (medication taken by mouth)

Repaglinide and glyburide tablets are medicines that target postprandial glucose. Studies showed that they also lower fasting blood glucose.

Acarbose lowers postprandial glucose. In a 3-year study, acarbose lowered A1C levels but not fasting blood glucose.

Repaglinide lowered A1C, fasting glucose, and postprandial glucose.

Combining Oral Drugs

When people took both metformin and nateglinide at the same time, the combination lowered fasting glucose, postprandial glucose, and A1C.

When people took both glyburide and metformin at the same time, the combination lowered fasting glucose, postprandial glucose, and A1C better than taking either medicine alone.

Oral Drugs and Insulin

In a study comparing two kinds of insulin -- lispro and NPH -- patients taking an oral medicine had an insulin added. Postprandial glucose and A1C were lower with insulin lispro than with NPH. Fasting glucose was lower with NPH insulin.

What were the limitations of the study?

More information is needed to show that controlling postprandial glucose lowers the risk of diabetes complications.

What are the implications of the study?

Drug treatment for type 2 diabetes should target both fasting blood glucose and postprandial blood glucose.