SEATTLE — Postprandial glucose levels seem to play an important and often overlooked role in cardiovascular disease in type 2 diabetes patients, Dr. Richard Hellman said at the annual meeting of the American Association of Clinical Endocrinologists.
“If you don't look at the postprandial events, you probably are not going to be successful in bringing the [HbA1c] levels into the target ranges that any of us would consider appropriate,” said Dr. Hellman, who is an endocrinologist at the University of Missouri-Kansas City and the president of the AACE.
Both the contribution of postprandial hyperglycemia and the cardiovascular risk decrease along a continuum, so the lower the HbA1c level that a patient can achieve, the lower that patient's cardiovascular risk will be, Dr. Hellman added.
The fact that postprandial hyperglycemia can be as crucial as fasting hyperglycemia was elucidated a few years ago in a study that computed the contributions of postprandial and fasting glucose to HbA1c levels in treated patients with diabetes, Dr. Hellman explained.
According to the study, when patients are not well controlled, the largest contribution to the HbA1c level is from fasting glucose.
However, as patients come under better glucose control, postprandial glucose accounts for a greater contribution.
For example, the study findings showed that when the HbA1c level is 8.5%–9.2%, postprandial hyperglycemia accounts for a little less than 50% of the HbA1c level, but when the HbA1c is lower than 7.3%, postprandial hyperglycemia accounts for about 70% (Diabetes Care 2003;26:881–5).
“I think this was a profound observation,” Dr. Hellman said.
Current data from a number of different surveys suggest that, overall, the lipid and glucose levels of patients with type 2 diabetes are not well managed, and that in recent years management has been getting worse, according to Dr. Hellman.
One of those studies recently reported that glycemic control (defined as an HbA1c level below 7%) was being achieved in only 36% of type 2 diabetes patients, compared with 45% of patients in the early 1990s (Diabetes Care 2004;27:17–20).
The optimal way for type 2 diabetes patients to achieve glycemic control—and thereby reduce their cardiovascular risk—is to adopt a multifactorial approach to management.
This approach should include diet modification, exercise, and aggressive treatment of hyperlipidemia, hypertension, and elevated glucose levels, Dr. Hellman said.