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Impact of postprandial glucose control on diabetes-related complications: How is the evidence evolving?

Sten Madsbad

Journal of Diabetes and Its Complications

Editorial comment by Sarah Cvach

Postprandial glucose (PPG) control needs to be considered when managing Diabetes.

Cardiovascular disease (CVD) is known to be one of the major complications of both type 1 and type 2 diabetes and the leading cause of mortality in this patient population.

Microvascular complications of Diabetes, including retinopathy, nephropathy and neuropathy are likewise playing a significant role in morbidity and mortality.

To avoid, minimize or prevent complications of Diabetes is a challenging task of the management of the disease. Landmark studies such as the United Kingdom Prospective Diabetes Study (UKPDS) have shown the association between HbA1c and microvascular complications. Strategies to lower HbA1c have led to reduction of cardiovascular risk. While in the past fasting plasma glucose (FPG) levels were in the focus, attention moved to the role of postprandial hyperglycaemia. Postprandial glucose (PPG) is a key contributor to overall glucose control as well as a predictor of microvascular and macrovascular events.

This article highlights the role of postprandial hyperglycaemia and its management. Faster insulin absorption of modern analogues and advances in insulin delivery modes might mimic more closely insulin secretory response to meals and may contribute in lowering PPG. Current evidence supports PPG control as an important factor to consider when managing Diabetes.