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Plasma Glucose Levels Throughout the Day and HbA_1c Interrelationships in Type 2 Diabetes

Implications for treatment and monitoring of metabolic control

Division of Endocrinology and Metabolic Disease, University of Verona Medical School, Verona, Italy

OBJECTIVE—To evaluate the extent of plasma glucose excursions with meals, the relations between plasma glucose levels at different times of the day, and the relations between the latter and HbA_1c in non–insulin-treated type 2 diabetic subjects.

RESEARCH DESIGN AND METHODS—Daily glucose profiles were assessed in non–insulin-treated type 2 diabetic patients. Outpatients at the diabetes clinic (n = 371; one daily plasma glucose profile) and at home (n = 30; five daily blood glucose profiles over 1 month) as well as inpatients (n = 455; profile of plasma glucose on the day of admission) were examined. Subjects had plasma/blood glucose assessment before and 2–3 h after breakfast, lunch, and dinner. HbA_1c was also measured.

RESULTS—After the meals many subjects had glucose levels >8.9 mmol/l (160 mg/dl) and/or glucose excursions >2.2 mmol/l (40 mg/dl). This was also often found when HbA_1c was satisfactory (<7%). The coefficients of simple correlation among plasma/blood glucose at different times of the day ranged from 0.52 to 0.88. Correlations between HbA_1c and plasma/blood glucose at different times of the day ranged from 0.44 to 0.67. The strongest correlation was between HbA_1c and mean daily glucose (r = 0.57–0.69). Multiple regression analyses showed that premeal but not postmeal plasma/blood glucose levels were independent predictors of HbA_1c.

CONCLUSIONS—These results suggest that 1) the majority of non–insulin-treated type 2 diabetic patients have exaggerated plasma/blood glucose excursions with meals, and many of them have higher-than-recommended glucose concentrations 2 h after the meals; 2) plasma/blood glucose levels throughout the day are not as strongly interrelated as one might believe; and 3) HbA_1c is more related to preprandial than postprandial plasma/blood glucose levels. These findings have potential implications for treatment and monitoring of metabolic control in type 2 diabetes.

Abbreviations: DCCT, Diabetes Control and Complications Trial • UKPDS, U.K. Prospective Diabetes Study

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