PMID- 26307902
OWN - NLM
STAT- MEDLINE
DCOM- 20160729
LR  - 20221207
IS  - 1530-891X (Print)
IS  - 1530-891X (Linking)
VI  - 21
IP  - 12
DP  - 2015 Dec
TI  - FASTING VERSUS POSTPRANDIAL HYPERGLYCEMIA AS A TREATMENT TARGET TO LOWER ELEVATED 
      HEMOGLOBIN A1C.
PG  - 1323-32
LID - 10.4158/EP14498.OR [doi]
AB  - OBJECTIVE: Postprandial hyperglycemia (PPHG) may need addressing when glycemic 
      control cannot be maintained in patients with type 2 diabetes mellitus. We 
      investigated whether glycated hemoglobin A1c (A1c) levels >/=7.0% can indicate 
      postprandial defects warranting prandial therapy after optimized basal insulin 
      therapy. METHODS: From 6 clinical trials of insulin glargine treatment, data were 
      pooled from 496 patients with A1c >/=7.0% after 24 weeks. Patient characteristics 
      and clinical outcomes were summarized according to fasting plasma glucose (FPG) 
      target achievement (<130 mg/dL), postprandial blood glucose (PPBG) levels, and 
      PPBG increments (DeltaPPBG). Basal and postprandial contributions to hyperglycemia 
      were determined. RESULTS: After 24 weeks of insulin glargine titration, A1c 
      change from baseline was greater in patients with FPG <130 mg/dL versus >/=130 
      mg/dL (-1.35% versus -1.11%, respectively; P = .0275), but with increased 
      confirmed hypoglycemia rates (blood glucose <70 mg/dL; 4.06 events/patient-year 
      versus 3.31 events/patient-year; P = .0170). However, increased severe 
      hypoglycemia rates were observed in patients with FPG >/=130 mg/dL. At week 24, 
      postprandial contributions to hyperglycemia increased (>60% regardless of PPBG). 
      Patients with high FPG had lower, but substantial, relative postprandial 
      contributions versus patients achieving FPG target. A similar pattern was 
      observed according to whether patients had a DeltaPPBG >/=50 mg/dL after any meal. 
      CONCLUSION: After optimized basal insulin therapy, elevated A1c is the most 
      effective indicator of residual PPHG, regardless of existent FPG or PPBG. When 
      confronted with an uncontrolled A1c after reasonable titration of basal insulin, 
      clinicians should be aware of probable postprandial contributions to 
      hyperglycemia and consider prandial therapy.
FAU - Shaefer, Charles
AU  - Shaefer C
FAU - Reid, Timothy
AU  - Reid T
FAU - Vlajnic, Aleksandra
AU  - Vlajnic A
FAU - Zhou, Rong
AU  - Zhou R
FAU - DiGenio, Andres
AU  - DiGenio A
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
DEP - 20150826
PL  - United States
TA  - Endocr Pract
JT  - Endocrine practice : official journal of the American College of Endocrinology 
      and the American Association of Clinical Endocrinologists
JID - 9607439
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin A)
SB  - IM
CIN - Endocr Pract. 2015 Dec;21(12):1439-41. PMID: 26307897
CIN - Endocr Pract. 2015 Dec;21(12):1436-8. PMID: 26401582
MH  - Adult
MH  - Aged
MH  - Blood Glucose/*analysis/metabolism
MH  - Clinical Trials, Phase III as Topic/statistics & numerical data
MH  - Diabetes Mellitus, Type 2/blood/*drug therapy/epidemiology
MH  - Fasting/*blood
MH  - Female
MH  - Glycated Hemoglobin/*analysis/metabolism
MH  - Humans
MH  - Hyperglycemia/blood/*drug therapy/epidemiology
MH  - Male
MH  - Middle Aged
MH  - Patient Care Planning
MH  - Postprandial Period/*drug effects
MH  - Randomized Controlled Trials as Topic/statistics & numerical data
MH  - Treatment Outcome
EDAT- 2015/08/27 06:00
MHDA- 2016/07/30 06:00
CRDT- 2015/08/27 06:00
PHST- 2015/08/27 06:00 [entrez]
PHST- 2015/08/27 06:00 [pubmed]
PHST- 2016/07/30 06:00 [medline]
AID - S1530-891X(20)39362-9 [pii]
AID - 10.4158/EP14498.OR [doi]
PST - ppublish
SO  - Endocr Pract. 2015 Dec;21(12):1323-32. doi: 10.4158/EP14498.OR. Epub 2015 Aug 26.