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Hyperglycemia Contributors in Newly Diagnosed T2 Patients

Apr 17, 2015
 

Should initial pharmacotherapy target basal glucose (BG) or postprandial glucose (PPG)?…

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Researchers from Sichuan University in China 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.

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 110mg/dL.( 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 110mg/DL(6.1 mmol/L) was chosen as the baseline.

The researchers concluded that, 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.

Practice Pearls:

  • In the newly diagnosed T2DM patients with mild hyperglycemia, PPG is a predominant contributor.
  • The importance of BG increased with increasing hyperglycemia severity. These findings suggest that therapy should target PPG or BG according to the severity of hyperglycemia.

X Kang. Contributions of Basal Glucose and Postprandial Glucose Concentrations to Hemoglobin A1c in the Newly Diagnosed Patients With Type 2 Diabetes—The Preliminary Study: Diabetes Technol. Ther. 2015 Mar 31; [EPub Ahead of Print].