from Diabetes In control

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This article originally posted March 10, 2009 and appeared in

Issue 459

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

er, 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. "

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.