Optimizing Postprandial Glucose Management in Adults With Insulin-Requiring Diabetes: Report and Recommendations

Abstract

Faster-acting insulins, new noninsulin drug classes, more flexible insulin-delivery systems, and improved continuous glucose monitoring devices offer unprecedented opportunities to improve postprandial glucose (PPG) management and overall care for adults with insulin-treated diabetes. These developments led the Endocrine Society to convene a working panel of diabetes experts in December 2018 to assess the current state of PPG management, identify innovative ways to improve self-management and quality of life, and align best practices to current and emerging treatment and monitoring options. Drawing on current research and collective clinical experience, we considered the following issues for the ∼200 million adults worldwide with type 1 and insulin-requiring type 2 diabetes: (i) the role of PPG management in reducing the risk of diabetes complications; (ii) barriers preventing effective PPG management; (iii) strategies to reduce PPG excursions and improve patient quality of life; and (iv) education and clinical tools to support endocrinologists in improving PPG management. We concluded that managing PPG to minimize or prevent diabetes-related complications will require elucidating fundamental questions about optimal ways to quantify and clinically assess the metabolic dysregulation and consequences of the abnormal postprandial state in diabetes and recommend research strategies to address these questions. We also identified practical strategies and tools that are already available to reduce barriers to effective PPG management, optimize use of new and emerging clinical tools, and improve patient self-management and quality of life.

Randomized Double-Blind Clinical Trial Comparing Ultra Rapid Lispro With Lispro in a Basal-Bolus Regimen in Patients With Type 2 Diabetes: PRONTO-T2D

“…In patients with longer duration of type 2 diabetes, as in the PRONTO-T2D study, management of postprandial hyperglycemia remains the primary unmet need, with a significant number of patients not meeting glycemic goals despite treatment with multiple agents as well as basal insulin (24). Therapeutic interventions to decrease PPG excursions may be as important as or more important than fasting glucose in reaching overall glycemic goals and in decreasing the risk of diabetes and cardiovascular complications (25,26). Epidemiology studies have shown the increased risk of cardiovascular disease and mortality associated with elevated PPG levels (27)(28)(29)(30).…”

Ultra rapid lispro improves postprandial glucose control compared with lispro in patients with type 1 diabetes: Results from the 26‐week PRONTO‐T1D study

“…Unfortunately, controlling postprandial glucose (PPG) excursions remains challenging. An Endocrine Society‐sanctioned working group recently published recommendations for optimizing PPG management in insulin‐treated adults that encompassed areas for future research, strategies for self‐management, advances in continuous glucose monitoring (CGM) and digital algorithms, as well as new insulins 6 . For optimal PPG control, an ideal prandial insulin should match carbohydrate intake by demonstrating faster absorption, more rapid onset, and shorter duration of action 7 .…”

Postprandial Glucose Spikes, an Important Contributor to Cardiovascular Disease in Diabetes?

“…Thus, controlling PBG is more challenging in these people. Controlling carbohydrate intake, food composition, and promoting physical activity to lower PBG in people with diabetes is important, along with interventional care (20,21).…”