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

Abstract

Clinical trials investigating whether glucose lowering treatment reduces the risk of CVD in diabetes have thus far yielded mixed results. However, this doesn't rule out the possibility of hyperglycemia playing a major causal role in promoting CVD or elevating CVD risk. In fact, lowering glucose appears to promote some beneficial long-term effects, and continuous glucose monitoring devices have revealed that postprandial spikes of hyperglycemia occur frequently, and may be an important determinant of CVD risk. It is proposed that these short, intermittent bursts of hyperglycemia may have detrimental effects on several organ systems including the vasculature and the hematopoietic system collectively contributing to the state of elevated CVD risk in diabetes. In this review, we summarize the potential mechanisms through which hyperglycemic spikes may increase atherosclerosis and how new and emerging interventions may combat this.

Role of Continuous Glucose Monitoring in Diabetic Patients at High Cardiovascular Risk: an Expert-based Multidisciplinary Delphi Consensus

“…Diabetes is a traditional risk factor for CV disease, carrying a higher risk for sudden cardiac death, accelerated atherosclerosis, ischaemic heart disease, cardiomyopathy, and HF (35). In addition, oscillating glucose is considered to have more deleterious effects than constant high glucose levels on endothelial function (36) and postprandial glycaemic spikes may be a more robust determinant of CV disease risk than average glucose levels (37). This is explained by the hyperglycaemia-induced activation of oxidative stress pathways and in ammation as well as by the rapid formation of advanced glycosylated end-products (AGEs) (38).…”

Postprandial Asymptomatic Glycemic Fluctuations after Gastrectomy for Gastric Cancer Using Continuous Glucose Monitoring Device

“…In addition, postprandial glucose spikes have recently been demonstrated in healthy subjects without conditions of impaired glucose tolerance, such as diabetes mellitus [ 23 ]. These spikes were also associated with the induction of endothelial dysfunction and oxidative stress, resulting in a risk of arteriosclerotic diseases, such as myocardial infarction [ 24 25 26 27 ]. Considering that marked postprandial glucose spikes were more commonly observed in TG-RY and DG-RY than in the other two procedures, R-Y reconstruction, which is a non-physiological reconstructive procedure in that food does not pass through the duodenum, might adversely influence postprandial asymptomatic glucose fluctuations, while the other procedures have relatively little impact.…”

Addressing Overbasalization to Achieve Glycemic Targets

“…The potential results of this overuse of basal insulin may be unintended outcomes such as weight gain and hypoglycemia 9 and postprandial hyperglycemia, which has been associated with an increased risk of cardiovascular disease and mortality. 10-12…”

“…The potential results of this overuse of basal insulin may be unintended outcomes such as weight gain and hypoglycemia 9 an increased risk of cardiovascular disease and mortality. [10][11][12] When Basal Insulin Dose Is More Than About 0.5 units/kg/d Although a maximum basal insulin dose has not been identified, once the basal insulin dose is over about 0.5 units/kg/d, clinicians should consider adding an injectable therapy to address postprandial hyperglycemia if the A1C remains above the desired target. 13,14 The rationale for this recommendation is based on basal insulin having a ceiling effective dose whereby fasting blood glucose reductions become proportionally smaller with increasing doses.…”