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

Abstract

Aims/IntroductionStudies on the relative contributions of fasting and postprandial hyperglycemia (FH and PPH) to glycated hemoglobin (HbA1c) in patients with type 2 diabetes have yielded inconsistent results. We aimed to assess the relationship by using continuous glucose monitoring in a multi‐ethnic cohort.Materials and MethodsA total of 100 adults with type 2 diabetes were assessed with 6‐day continuous glucose monitoring and HbA1c. Area under the curve (AUC) ≥5.6 mmol/L was defined as AUCTOTAL. AUC equal to or greater than each preprandial glucose for 4‐h duration was defined as AUCPPH. The total PPH (AUCTPPH) was the sum of the various AUCPPH . The postprandial contribution to overall hyperglycemia was calculated as (AUCTPPH / AUCTOTAL) × 100%.ResultsThe present study comprised of Malay, Indian, and Chinese type 2 diabetes patients at 34, 34 and 28% respectively. Overall, the mean PPH significantly decreased as HbA1c advanced (mixed model repeated measures adjusted, beta‐estimate = −3.0, P = 0.009). Age (P = 0.010) and hypoglycemia (P = 0.006) predicted the contribution difference. In oral antidiabetic drug‐treated patients (n = 58), FH contribution increased from 54% (HbA1c 6–6.9%) to 67% (HbA1c ≥10%). FH predominance was significant in poorly‐controlled groups (P = 0.028 at HbA1c 9–9.9%; P = 0.015 at HbA1c ≥10%). Among insulin users (n = 42), FH predominated when HbA1c was ≥10% before adjustment for hypoglycemia (P = 0.047), whereas PPH was numerically greater when HbA1c was <8%.Conclusions FH and PPH contributions were equal in well‐controlled Malaysian type 2 diabetes patients in real‐world practice. FH predominated when HbA1c was ≥9 and ≥10% in oral antidiabetic drug‐ and insulin‐treated patients, respectively. A unique observation was the greater PPH contribution when HbA1c was <8% despite the use of basal and mealtime insulin in this multi‐ethnic cohort, which required further validation.

Relative contributions of preprandial and postprandial glucose exposures, glycemic variability, and non-glycemic factors to HbA 1c in individuals with and without diabetes

“…Furthermore, glycemic features explained a much larger proportion of the variation in those with T2D than in the non-diabetic population. Other studies using CGM for assessment of glycemia under free-living conditions have also found equal contributions of fasting and postprandial hyperglycemia to HbA 1c in patients with T2D, but with a tendency of a greater contribution of PPG at lower HbA 1c concentrations and higher contribution of fasting hyperglycemia at higher HbA 1c concentrations 24 – 26 . The latter result is in accordance with the findings by Monnier et al 9 who suggested that the relative contribution of PPG decreased, whereas the relative contribution of fasting glucose increased, from the lowest to the highest HbA 1c quintile among non-insulin-treated T2D patients with HbA 1c ranging from ~6 to 12% (42–108 mmol/mol).…”

Chemical Composition, Antioxidant Potential, and Blood Glucose Lowering Effect of Aqueous Extract and Essential Oil of Thymus Serrulatus Hochst. Ex Benth

“…It is argued that postprandial plasma glucose level is more reflective of glucose control than fasting plasma glucose, thus this may be more useful for monitoring diabetic patients ( Shahram and Nargess, 2008 ; Min Park et al, 2009 ; Lim et al, 2017 ). The elevated postprandial glucose level is considered an independent risk factor for the development of macrovascular complications associated with diabetes and impaired glucose tolerance.…”

Different Analysis of β-Cell Dysfunction as Fasting Glucose Progresses in Obese and Nonobese Newly Diagnosed Type 2 Diabetic Patients

“…However, HbA1c is not correlated with FBG in subjects without diabetes [15]. Some studies have shown that with the increase of HbA1c, the contribution of postprandial blood glucose excurses, while the contribution of FBG increses [16–18].…”