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Treatment of post-challenge glucose (PCG) levels may reduce cardiovascular disease and mortality associated with type 2 diabetes. Hyperglycemia has been shown in prior research to add significantly to adverse outcomes associated with type 2 diabetes. Recent studies have indicated that higher than normal PCG may be an independent factor associated with morbidity and mortality.
The investigators undertook a review of published data to evaluate the association of elevated PCG levels with cardiovascular outcomes and all-cause mortality in type 2 diabetes and to establish the strength of this association in comparison to fasting blood glucose (FPG) levels.
They conducted a MEDLINE search of English-language articles published from 1980-2001, supplemented by a search of bibliographies and references supplied by content experts. They used specific criteria to find articles addressing the association of PCG and cardiovascular morbidity/mortality and/or all-cause mortality.
They found 4,242 pertinent references in the literature. They finally accepted 14 studies for the review, 12 prospective and 2 cross-sectional.
Twelve of the studies (85 percent) documented a positive association between elevated PCG and cardiovascular morbidity/mortality and/or all-cause mortality in type 2 diabetes.
Seven studies provided direct comparison data on FPG and PCG levels. Five studies (71 percent) indicate that PCG is a better predictor of cardiovascular morbidity/mortality and/or all-cause mortality than FPG. The other 2 studies indicated no association between either FPG or PCG and morbidity or mortality.
"Fasting plasma glucose is an important screening tool in diabetes," said investigator Myriam Bernal, research associate at ZYNX Health in Los Angeles. "We also found that there is powerful evidence in the wider medical literature to support the belief that post challenge glucose, if it’s higher, is directly correlated with cardiovascular outcomes. It should be targeted by physicians." The study was supported by a grant from Novartis Pharmaceuticals.