Target for Glycemic Control
Concentrating on glucose
- Louis Monnier, MD and
- Claude Colette, PHD
- From the Laboratory of Human Nutrition, Institute of Clinical Research, Montpellier, France.
- Corresponding author: Louis Monnier, louis.monnier{at}inserm.fr.
It is commonly admitted that the glycemic control of patients with type 2 diabetes proceeds from a complex “alchemy” in which
the respective contributions of both fasting and postprandial glucose are still a subject of debate (1). A1C, which remains the gold standard for assessing glucose homeostasis, is an integration of both fasting and postprandial
glucose variations over a 3-month period (2). From a mathematical point of view, the theory can be formulated as follows (3):
where FPG (t) and PPG (t) are the time courses of fasting and postprandial glucose, respectively.
As a consequence, the glycemic control of patients with type 2 diabetes can be schematically depicted by the “glucose triad,” whose components are as follows: A1C, fasting, and postprandial glucose levels. At present, and even though the debate remains wide open, it seems that the best assessment of glycemic control is provided by the determination of the three above-mentioned components. Most recommendations that have been published by medical organizations in different countries take into account the three parameters, even though the position statements differ around the world, but also within the same country (4).
IMPORTANCE OF THE FOUR-POINT DIURNAL GLYCEMIC PROFILE
A tool for integrating the different periods of daytime
Whereas many physicians continue to emphasize fasting glucose and A1C to guide management of diabetes, observational studies have indicated that glucose testing at postprandial and postabsorptive time points could play an important role (5,6). For instance, lessons from physiology tell us that humans spend half of their lives in postprandial states (7,8). The postprandial state, with respect to glucose, is defined as a 4-h period that immediately follows ingestion of a meal (7). During this period, dietary carbohydrates are progressively hydrolyzed through several sequential enzymatic actions. Even though the insulin response rapidly reduces the postprandial glucose excursion with a return to baseline levels within <2 h, the overall …
