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How Do We Diagnose Diabetes and Measure Blood Glucose Control?

View 2: (Measuring Control) Consensus Statement: Postprandial Blood Glucose

	Introduction

 
Individuals with diabetes are at increased risk of developing microvascular complications (retinopathy, nephropathy, and neuropathy) and cardiovascular disease (CVD). The Diabetes Control and Complications Trial (DCCT)¹ and U.K. Prospective Diabetes Study (UKPDS)² showed that treatment programs resulting in improved glycemic control, as measured by HbA_1c, reduced the microvascular complications of diabetes. The effect of these treatment programs on reducing CVD was less clear. However, some epidemiological studies suggest that there may be a relationship between glycemic levels and CVD.

In the management of diabetes, health care providers usually assess glycemic control with fasting plasma glucose (FPG) and premeal glucose measurements, as well as by measuring HbA_1c. Therapeutic goals for HbA_1c and preprandial glucose levels have been established based on the results of controlled clinical trials. Unfortunately, the majority of patients with diabetes fail to achieve their glycemic goals. Elevated postprandial glucose (PPG) concentrations may contribute to suboptimal glycemic control. Postprandial hyperglycemia is also one of the earliest abnormalities of glucose homeostasis associated with type 2 diabetes and is markedly exaggerated in diabetic patients with fasting hyperglycemia.

Several therapies targeted toward lowering PPG excursions are now available and have been shown to improve glycemic control as measured by HbA_1c. However, many questions remain unanswered regarding the definition of PPG and, perhaps most importantly, whether postprandial hyperglycemia has a unique role in the pathogenesis of diabetic complications and should be a specific target of therapy. To address these issues and to provide guidance to health care providers, the American Diabetes Association (ADA) convened a consensus development conference on 24–26 January 2001 in Atlanta, Georgia.

A seven-member panel of experts in diabetes, endocrinology, and metabolism heard selected abstracts and presentations from invited speakers. The panel was then asked to develop a consensus position on the following questions:

1.  How is PPG . . . [Full Text of this Article]

	QUESTION 1: How is PPG defined?

	QUESTION 2: What is the relationship among PPG, FPG, and HbA1c?

	QUESTION 3: What is the contribution of PPG to the long-term complications of diabetes?

	QUESTION 4: Under what circumstances should people with diabetes be tested for PPG?

	QUESTION 5: What are the benefits and risks of specifically lowering PPG in an effort to achieve better glycemic control?

	QUESTION 6: What additional research needs to be performed to clarify the role of PPG in the medical management of diabetes?

	Appendix

	Acknowledgments

	Footnotes

	References

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