You are correct...
Which is worse -- fasting, preprandial, or postprandial
hyperglycemia?
1. Fasting
2. Preprandial
3. postprandial
4. All of the above
Answer: All of the above, but Fasting would probably
be the second best answer.
This is a difficult question to answer. At face value, they are all
important. The test most validated to correlate with risk for complications
is the glycated hemoglobin (A1C) test. To the extent that fasting, preprandial,
and postprandial glucose all correlate with A1C, they all are important.[1]
If you could only get one controlled, perhaps the fasting glucose would
be the most important because it often reflects a prolonged period of
glycemic control (from bedtime to the morning), as compared with the
postprandial glucose, which theoretically may reflect a rather brief
period of control.
That said, there are studies in which the fasting glucose is left to
its own devices and the postprandial glucose is controlled -- and vice
versa -- which suggest that both are important and that you can achieve
similar levels of control with both approaches. The logical approach,
however, is to attempt to control the glucose throughout the day. If
weI only had access to 1 glucose monitoring strip a day, you might initially
use it to titrate medical and lifestyle therapy to control the fasting
glucose. Once that was achieved, you could have patients vary their
monitoring before meals and bedtime day by day, with adjustments to
try to lower all the premeal values to the 100 mg/dL range (70 mg/dL
being clearly too low and 130 mg/dL being pretty clearly too high).
Once that was achieved, you could consider switching to checking blood
glucoses occasionally after meals to see if the postprandial glucose
could be optimized with further adjustments. However, from the studies,
it would make sense, that occasional fasting and premeal glucoses would
be essential to check to screen for unrecognized hypoglycemia.
References
1. Rohfling CL, Wiedmeyer HM, Little RR, et al. Defining the relationship
between plasma glucose and HbA(1c): analysis of glucose profiles and
HbA(1c) in the Diabetes Control and Complications Trial. Diabetes Care.
2002;25:275-278. Abstract
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