Contributions of Basal Glucose and Postprandial Glucose Concentrations to Hemoglobin A1c in the Newly Diagnosed Patients with Type 2 Diabetes—The Preliminary Study

Abstract

Objective: The aim of this preliminary study is to investigate contributions of basal glucose (BG) and postprandial glucose (PPG) increments to overall hyperglycemia in newly diagnosed patients with type 2 diabetes mellitus (T2DM). Research Design and Methods: We evaluated the relative contributions of BG and PPG to overall hyperglycemia in 59 newly diagnosed T2DM patients according to BG baseline value of 6.1 mmol/L and 24-h glucose profiles of normal glucose tolerance (NGT) subjects obtained by continuous glucose monitoring as baseline, respectively. Results: When the baseline was 24-h glucose profiles of the NGT subjects, the relative contributions of PPG in the T2DM patients with hemoglobin A1c (HbA1c) levels of £ 7.0%, 7.0-9.0%, and > 9.0% were 57.58%, 44.69%, and 21.56%, respectively. When the baseline value was equal to 6.1 mmol/L, the relative contributions of PPG in the T2DM patients with HbA1c levels of £ 7.0%, 7.0-9.0%, and > 9.0% were 77.23%, 53.43%, and 22.78%, respectively. Compared with the 24-h glucose profiles of the NGT subjects as the baseline, the relative contribution of PPG was overestimated by about 10-20% in the T2DM patients with HbA1c levels of £ 9.0% when 6.1 mmol/L was chosen as the baseline. Conclusions: In the newly diagnosed T2DM patients with mild hyperglycemia, PPG is a predominant contributor, whereas the relative contributions of BG gradually increase from mild to severe hyperglycemia and obviously exceed PPG in the T2DM patients with HbA1c levels of > 9.0%. This finding implies that the initial pharmacotherapy may target PPG in those patients with mild hyperglycemia and target BG in those patients with severe hyperglycemia.

Postprandial or Fasting Hyperglycemia: Time to Move On?

“…In summary, the relative contribution of PPG as compared with FPG is high in those with the lowest HbA1c values, both in people on oral agents and as now reported by Kang et al 1 also in newly diagnosed patients. But taking all the available evidence together, it is not surprising that treatment guidelines do not recommend specific targeting of PPG values in those with lower HbA1c values.…”

“…I n this issue of Diabetes Technology & Therapeutics, Kang et al 1 report on the relative contributions of fasting plasma glucose (FPG) and postprandial glucose (PPG) to overall glycemia as a function of different hemoglobin A1c (HbA1c) ranges in untreated, newly diagnosed patients with type 2 diabetes. Using continuous glucose monitoring, they found that PPG accounted for 77% of overall hyperglycemia in those with an HbA1c level below 7%, but only 23% in those with an HbA1c level above 9%.…”

Relationship of glycated hemoglobin, and fasting and postprandial hyperglycemia in type 2 diabetes mellitus patients in Malaysia

“…This added further information on the findings of previous studies, which included either drug‐naïve or OAD‐treated type 2 diabetes among Caucasians and East Asians only, except Kikuchi et al . who also recruited those taking basal insulin. In addition, Wang et al .…”

“…with a predominance of PPH at lower HbA 1c levels were reported. One of the main differences of these studies was on the HbA 1c threshold in which the shift of FH and PPH predominance occurred. Wang et al .…”

“…of fasting hyperglycemia (FH) predominating at higher HbA 1c levels and postprandial hyperglycemia (PPH) predominating at lower HbA 1c levels being the most widely expounded. Several other studies have been carried out with contrasting results, perhaps because of differences in study populations, methodologies and antihyperglycemic therapies.…”