Implications of Postprandial Glucose and Weight Control in People With Type 2 Diabetes
Understanding and implementing the International Diabetes Federation guidelines
- Baptist Gallwitz, MD
- From the Department of Medicine IV, Eberhard-Karls-University Tübingen, Tübingen, Germany.
- Corresponding author: Baptist Gallwitz, baptist.gallwitz{at}med.uni-tuebingen.de.
The International Diabetes Federation (IDF) recently published guidelines for the management of postmeal hyperglycemia. These guidelines were established in view of the risk of postmeal hyperglycemia for vascular events. Because of the rising incidence and prevalence of diabetes and its complications, the IDF took action to state useful strategies for the treatment of diabetes, focusing on the detection and therapy of postprandial hyperglycemia. Besides nonpharmacological measures (blood glucose self-control and diet), drugs such as short-acting insulinotropic agents (sulfonylureas and glinides), glucosidase inhibitors, insulin, and incretin-based therapies can specifically be used to act on postmeal glucose elevations. The specific action profiles of these agents are shown and discussed with respect to the IDF guidelines.
POSTMEAL HYPERGLYCEMIA AS A RISK FACTOR IN TYPE 2 DIABETES
Type 2 diabetes is a chronic and progressive disease that affects ∼250 million people worldwide today, with an increasing incidence in the years to come (1). With this epidemic dimension, type 2 diabetes is of global concern. Poor control of the disease is a leading cause of death in most developed countries and is associated with microvascular complications (renal failure and blindness due to retinopathy) and macrovascular complications (cardiovascular disease and stroke) as well as neurological complications such as diabetic neuropathy. Macrovascular complications are the major cause of death in type 2 diabetic patients (2–7).
Numerous epidemiological studies have shown that postprandial hyperglycemia substantially adds to the micro- and macrovascular risk not only in type 1 and type 2 diabetes, but already in impaired glucose tolerance (2–4,8). The associations between postmeal hyperglycemia and markers of cardiovascular disease such as oxidative stress, inflammation, endothelial dysfunction, and carotid IMT have been well characterized. In addition, postprandial hyperglycemia has also been connected with the incidence of carcinomas and cognitive dysfunction in elderly type 2 diabetic patients (9–11).
Large intervention trials …
