Glycemic Treatment in Type 1 and Type 2 Diabetes
- Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, New York, and is affiliated with the Division of Endocrinology, Mount Sinai School of Medicine, New York, New York
- ADA, American Diabetes Association
- CGM, continuous glucose monitoring
- CSII, continuous subcutaneous insulin infusion
- DAISY, Diabetes Autoimmunity Study in the Young
- DCCT, Diabetes Control and Complications Trial
- DirectNet, Diabetes Research in Children Network
- DKA, diabetic ketoacidosis
- GADA, GAD antibody
- IA-2, insulinoma-associated antibody 2
- STOP-NIDDM, Study to Prevent Noninsulin-Dependent Diabetes Mellitus
This is the second in a series of articles on presentations at the American Diabetes Association’s 66th Scientific Sessions, Washington, DC, 9–13 June 2006.
A pilot project is underway to offer the Perspectives on the News commentaries as a monthly Web-based CME activity. Please access www.ada.procampus.net to view our initial efforts. We look forward to your comments.
Postprandial glycemia
At the meeting of the Council on Nutritional Science and Metabolism, Joan V.C. Hill (Natick, MA) introduced a session addressing the implications of postprandial blood glucose monitoring by reminding the audience that the American Diabetes Association (ADA) recommends a target HbA1c (A1C) of ≤7% but that the most recent National Health and Nutrition Examination Survey suggests that >60% of persons with diabetes fail to meet this goal. In a Quest laboratories analysis of 14.3 million A1C tests performed for diabetes diagnosis codes, half were shown to be above goal, although the average decreased from 7.8% in 2001 to 7.2% in 2005. An important question is the contribution of postprandial blood glucose to A1C, with the corollary being the determination of reasonable postprandial blood glucose targets, with Hill asking whether targeting postprandial blood glucose can improve metabolic control or, more importantly, improve outcome, recognizing the difficulty of determining the relationship between postprandial blood glucose and outcome. “The clear message,” Hill concluded, is that “achieving A1C close to goal [will require] monitoring postprandial glucose.”
Martin Abrahamson (Boston, MA) reminded the audience, “Most of our lives are spent in the postprandial state,” with the preprandial state not beginning until 10 h after ingestion of food, perhaps in most persons only from 4:00 to 8:00 a.m. Thus, measurement of fasting glucose may represent a state not particularly representative of that encountered through the day. To achieve the target goal of A1C as close to normal …
