Guidelines
Guideline for management of postmeal glucose in diabetes

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Methodology

This update builds on the original IDF guideline for the management of postmeal glucose published in 2007. The methodology used in the development of this guideline is not described in detail here, as it broadly follows the principles described in the IDF guide for guidelines (www.idf.org).
In summary:

  • The update was overseen by a Guideline Development Group of clinicians and researchers with expertise in the topic and guideline development (see Appendix A)

  • Geographical representation included

Objective

The purpose of this guideline is to consider the evidence on the relationship between postmeal glucose and glycaemic control (HbA1c), and with diabetes outcomes. Based on this information, recommendations for the appropriate management and monitoring of postmeal glucose in type 1 and type 2 diabetes have been developed. Management of postmeal glucose in pregnancy has not been addressed in this guideline.

The recommendations are intended to assist clinicians and organizations in developing

Summary of recommendations

As a basis for developing the recommendations, the Guideline Development Group addressed four questions relevant to the role and importance of postmeal hyperglycaemia in diabetes management. The evidence supporting the recommendations is shown as evidence statements (with the level of evidence indicated at the end of the statement).

Definition of postprandial glucose and contribution to overall hyperglycaemia

In people with diabetes, the total exposure to glucose is the sum of two components [28]:

  • (i)

    The normal physiological glucose exposure as observed in healthy individuals

  • (ii)

    The additional glucose exposure observed in hyperglycaemic individuals which has been defined as all plasma glucose values above 5.5 mmol/l (99 mg/dl). This additional glucose exposure can be further divided into its two subcomponents – basal/preprandial and postprandial hyperglycaemia

Calculating the absolute and relative

Question 1

Is postmeal hyperglycemia harmful?

Epidemiological studies have shown a strong association between postmeal and postchallenge glycaemia and cardiovascular risk and outcomes [45], [46], [47], [48]. Furthermore, a large and growing body of evidence shows a relationship between postmeal hyperglycaemia and oxidative stress [49], carotid IMT [50] and endothelial dysfunction [49], [51], all of which are known markers of cardiovascular disease. Postmeal hyperglycaemia is also linked to retinopathy [52]

Question 2

Is the treatment of postmeal hyperglycaemia beneficial in improving clinical outcomes and glycaemic control (HbA1c)?

Question 3

Which therapies are effective in controlling postmeal plasma glucose?

Question 4

What are the targets for postmeal glycaemic control and how should they be assessed?

Continuous glucose monitoring

The use of continuous glucose monitoring (CGM) for monitoring diabetes is increasing [123]. CGM employs a sensor, a data storage device and a monitor. The sensor measures glucose every 1–10 min and transmits this reading to a data storage device. Results can be either downloaded retrospectively by the physician, or displayed in “real time” in the monitor. CGM provides information on glucose levels, patterns and trends, thereby reflecting the effects of medication, meals, stress, exercise and

Clinical implications

Most guidelines, including the updated IDF Global Guideline for Type 2 Diabetes, recommend a general HbA1c target of <7.0% while emphasizing the need to take into account patient factors in determining the appropriate target for an individual.

The data reviewed in this guideline support the concept that postmeal glucose makes a significant contribution to overall glycaemia reflected in the HbA1c level and that the relative contribution increases at lower levels of HbA1c, especially below 8.0%.

Conflict of interest

Members of the Guideline Development Group have declared relevant dualities of interest in the topic and in relationships with commercial enterprises, governments and non-governmental organizations. No fees were paid to the Guideline Development Group members in connection with the current activity. Members of the Guideline Development Group (except for Antonio Ceriello and Stephen Colagiuri) were not aware of the identity of the sponsors during the entire development of this guideline. The

Acknowledgements

This update of the 2007 PostMeal Glucose was supported by unrestricted educational grants from Bristol-Myers Squibb, Lilly Diabetes, Novo Nordisk A/S, Nutricia, Roche Diabetes Care. These companies did not take part in any aspect of the development of this guideline.

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  • Cited by (0)

    1

    See Appendix A for author group.

    2

    For correspondence: [email protected].

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