Postprandial glycaemia: a plea for the frequent use of delta postprandial glycaemia in the treatment of diabetic patients

• Published in: Diabetes & metabolism 2006-04, Vol.32 (2), p.187-192
• Main Authors: Slama, G, Elgrably, F, Sola, A, Mbemba, J, Larger, E
• Format: Article
• Language: English
• Subjects: Alpha-glucosidases inhibitors; Analogues lents; Analogues rapides; Auto-surveillance glycémique; Biological and medical sciences; Blood Glucose - metabolism; Delta glycémique post-prandial; Diabetes Mellitus - blood; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Excursion glycémique post-prandiale; Fasting; Glinides; Glycaemic index; Glycated haemoglobin; Humans; Hyperglycemia - prevention & control; Hyperglycémie post-prandiale; Hémoglobine glyquée; Index glycémique; Inhibiteurs des alphaglucosidases; Medical sciences; Monitoring, Physiologic - standards; Postprandial delta glycaemia; Postprandial glycaemic excursion; Postprandial hyperglycaemia; Postprandial Period; Rapid-acting analogs; Self-blood glucose monitoring; Slow-acting analogs
• ISSN: 1262-3636; 1878-1780
• DOI: 10.1016/S1262-3636(07)70268-9

Postprandial hyperglycaemia is a phenomenon often neglected by patients as well as doctors. While patients only voluntarily measure morning and preprandial capillary glycaemia, physicians do not encourage the measurement of anything further. The specific role of postprandial hyperglycaemia in the determination of late diabetes complications, such as micro- and macroangiopathy, remains controversial. It is however undeniable that the postprandial glycaemic excursion plays an important role in total hyperglycaemia reflected by an increase in glycated haemoglobin. The postprandial glycaemia measurement or, more appropriately, the postprandial glycaemic excursion (the difference between postprandial and preprandial glycaemia, also called the postprandial delta glycaemia), is important to measure and there are specific tools to correct it when abnormal. Postprandial delta glycaemia should lie between 30 and 50 mg/dl. It is thus suggested to measure it not necessarily on a daily basis, but when it is expected that the glycaemic couple, or “pre-postprandial couple”, is high. The specific tools for treatment of postprandial hyperglycaemia can be dietetic (carbohydrate quantity reduction or ingestion of fiber-rich and/or low glycaemic index foods) or medicinal. Among the specific medicinal treatments are the alpha-glucosi-dase-inhibitors (which can be used for both type 1 and type 2 diabetic patients), glinides and fast-acting insulins. Rather than first treating fasting and interprandial hyperglycaemia, as has been commonly done by physicians, the authors recommend the simultaneous treatment of pre-, inter- and postprandial hyperglycaemia. The optimal time at which to evaluate postprandial glycaemia is approximately 1 h and 15 minutes for type 1 and type 2 diabetic patients. Repenser l'utilisation des glycémies post-prandiales des diabétiques; pour un calcul du delta glycémique post-prandial L'hyperglycémie post-prandiale est un phénomène trop souvent négligé par les patients aussi bien que par les médecins, les premiers pratiquant plus volontiers la mesure de la glycémie capillaire au réveil et avant les repas, les seconds ne réclamant aucune autre information. Même si son rôle spécifique dans le déterminisme des complications tardives du diabète, micro- et macroangiopathiques, reste un sujet controversé, il est incontestable que l'excursion glycé-mique post-prandiale joue un rôle important dans l'hyperglycémie globale et l'élévation de l'hémoglobine glyquée. La