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Post-Prandial vs. Fasting Glucose: An End to the Debate?

In patients with existing CVD, study finds no difference? Or does it?

Researchers and physicians have long debated whether it’s more important to strive to control fasting blood glucose levels or the spikes in glucose that occur after eating (post-prandial levels). Now a study, recently published, shows there is no significant benefit to choosing one over the other in trying to prevent the progression of cardiovascular disease.

The study, conducted at 105 centers by researchers in 17 countries, was halted early when it became apparent that it didn’t matter whether physicians treated hyperglycemia (high blood glucose levels) following a meal or between meals. According to study investigators, neither approach succeeded in reducing the risk for further cardiovascular events. An editorial accompanying the study suggests that, because all of the patients in this study had already been diagnosed with type 2 diabetes and had recently experienced myocardial infarctions, it may have been too late to prevent the progression of disease.

“Differences in post-prandial glycemia between the two therapies were noted, but were less than expected and may have not been enough to have had an impact on the advanced atherosclerosis of this patient population,” said Scott Jacober, research physician for Eli Lilly and Company. “As with other trials (DIGAMI-2, ACCORD, ADVANCE and VADT), research in this area is challenging and further investigations on the relationship between glycemia and cardiovascular outcomes may be warranted.”

Antonio Ceriello, of the University of Warwick’s Clinical Science Research Center, concludes in an accompanying editorial that this study underscores the need to control hyperglycemia, including post-prandial hyperglycemia, much earlier in the progression of diabetes, when doing so can make a much greater difference in preventing diabetes-related complications.

“We have, again, learned how difficult is the optimal control of hyperglycemia, a goal which seems to be mandatory at a very early stage of diabetes,” he wrote.

Publisher’s comment:

As the study states, this information comes from patients who have already had a cardiovascular event.  So, for people who have not had a cardiovascular event and are trying to prevent one, this study has not answered the question. The question it has answered is that treating to normal blood sugars by looking at post-prandial and fasting blood sugars are important in improving a person’s quality of life.

Note: The American Diabetes Association, in conjunction with the American Heart Association and the American College of Cardiology, issued a position statement in December 2008 regarding intensive glycemic control and the prevention of cardiovascular events and the implications of ACCORD, ADVANCE, and VA Diabetes Trials. This statement was published in Diabetes Care and can be found at http://care.diabetesjournals.org/cgi/content/extract/32/1/187.

Diabetes Care, March 2009