Nonfasting Plasma Glucose is a Better Marker of Diabetic Control Than Fasting Plasma Glucose in Type 2 Diabetes

A Avignon; A Radauceanu; L Monnier

doi:10.2337/diacare.20.12.1822

Original Articles

Nonfasting Plasma Glucose is a Better Marker of Diabetic Control Than Fasting Plasma Glucose in Type 2 Diabetes

A Avignon, MD,
A Radauceanu, MD and
L Monnier, MD

University Hospital of Montpellier, Department of Metabolism, Lapeyronie Hospital Montpellier, France

Address correspondence and reprint requests to Antoine Avignon, MD, Service des Maladies Metaboliques, Hôpital Lapeyronie 371, Av. Doyen G. Giraud, 34295 Montpellier Cedex 5, France.

Diabetes Care 1997 Dec; 20(12): 1822-1826. https://doi.org/10.2337/diacare.20.12.1822

Abstract

OBJECTIVE To evaluate the relative value of plasma glucose (PG) at different time points in assessing glucose control of type 2 diabetic patients.

RESEARCH DESIGN AND METHODS Glycemic profiles, i.e., PG at prebreakfast (8:00 A.M.), prelunch (11:00 A.M.), postlunch (2:00 P.M.), and extended postlunch (5:00 P.M.) times over the same day, were obtained in 66 type 2 diabetic patients on an ambulatory basis. The different time points of PG were compared with a measurement of HbA_1c made in a reference laboratory.

RESULTS Extended postlunch PG was lower than prebreakfast PG (104 ± 21 vs. 133 ± 35 mg/dl, P < 0.02) in patients demonstrating good diabetic control (HbA_1c ≤ 7.0%), was not different from prebreakfast PG (149 ± 47 vs. 166 ± 26 mg/dl, NS) in patients demonstrating fair diabetic control (7.0% < HbA_1c ≤ 8.5%), and was higher than prebreakfast PG (221 ± 62 vs. 199 ± 49 mg/dl, P ≤ 0.01) in those demonstrating poor diabetic control (HbA_1c ≤ 8.5%). Prebreakfast, prelunch, postlunch, and extended postlunch PG values were all significantly correlated with HbA_1c. Multiple linear regression analysis demonstrated that postlunch PG and extended postlunch PG correlated significantly and independently with HbA_1c, but that prebreakfast PG and prelunch PG did not. Moreover, postlunch PG and extended postlunch PG demonstrated better sensitivity, specificity, and positive predictive value in predicting poor glycemic control than did prebreakfast PG or prelunch PG.

CONCLUSIONS In type 2 diabetes, postlunch PG and extended postlunch PG are better predictors of glycemic control than fasting plasma glucose (FPG). We therefore suggest that they be more widely used to supplement, or substitute for, FPG in evaluating the metabolic control of type 2 diabetic patients.