Endocrinol Metab.  2020 Jun;35(2):290-297. 10.3803/EnM.2020.35.2.290.

Fasting and Postprandial Hyperglycemia: Their Predictors and Contributions to Overall Hyperglycemia in Korean Patients with Type 2 Diabetes

• Moon J
• Kim JY
• Yoo S
• Koh G

• KMID: 2503259
• DOI: http://doi.org/10.3803/EnM.2020.35.2.290

Abstract

Background
This study aimed to identify factors that affect fasting hyperglycemia (FHG) and postprandial hyperglycemia (PPG) and their contributions to overall hyperglycemia in Korean patients with type 2 diabetes mellitus (T2DM).
Methods
This was a retrospective study conducted on 194 Korean T2DM patients with 7-point self-monitoring blood glucose (SMBG) profiles plotted in 4 days in 3 consecutive months. We calculated the areas corresponding to FHG and PPG (area under the curve [AUC]FHG and AUCPPG) and contributions (%) in the graph of the 7-point SMBG data. The levels of glycated hemoglobin (HbA1c) were categorized by tertiles, and the contributions of FHG and PPG were compared.
Results
The relative contribution of FHG increased (44.7%±5.6%, 58.0%±4.4%, 66.5%±2.8%; PANOVA=0.002, PTREND <0.001), while that of PPG decreased (55.3%±5.5%, 42.0%±4.4%, 33.5%±2.8%; PANOVA=0.002, PTREND <0.001) with the elevated HbA1c. Multivariate analysis showed that HbA1c (β=0.615, P<0.001), waist circumference (β=0.216, P=0.042), and triglyceride (β=0.121, P=0.048) had a significant association with AUCFHG. Only HbA1c (β=0.231, P=0.002) and age (β=0.196, P=0.009) was significantly associated with AUCPPG.
Conclusion
The data suggested that in Korean T2DM patients, FHG predominantly contributed to overall hyperglycemia at higher HbA1c levels, whereas it contributed to PPG at lower HbA1c levels. It is recommended that certain factors, namely age, degree of glycemic control, obesity, or triglyceride levels, should be considered when prescribing medications for T2DM patients.

Keyword

Hyperglycemia; Fasting; Glycated hemoglobin A

Figure

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  Fig. 1 Measurement of seven-point self-monitoring of blood glucose (SMBG) and glycated hemoglobin (HbA1c).

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  Fig. 2 The relative contributions of fasting hyperglycemia (FHG) and postprandial hyperglycemia (PPG) to overall hyperglycemia according to the tertiles of glycated hemoglobin (HbA1c). AUC, area under the curve.

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  Fig. 3 The relative contributions of (A) fasting hyperglycemia (FHG) and (B) postprandial hyperglycemia (PPG) to overall hyperglycemia according to the tertiles of glycated hemoglobin (HbA1c). Data are expressed as the mean±standard error. PANOVA, P value by analysis of variance; PTREND, P value by linear trend test.

Reference

1. Avignon A, Radauceanu A, Monnier L. Nonfasting plasma glucose is a better marker of diabetic control than fasting plasma glucose in type 2 diabetes. Diabetes Care. 1997; 20:1822–6.

2. Rohlfing CL, Wiedmeyer HM, Little RR, England JD, Tennill A, Goldstein DE. Defining the relationship between plasma glucose and HbA(1c): analysis of glucose profiles and HbA(1c) in the Diabetes Control and Complications Trial. Diabetes Care. 2002; 25:275–8.

3. Bonora E, Calcaterra F, Lombardi S, Bonfante N, Formentini G, Bonadonna RC, et al. Plasma glucose levels throughout the day and HbA(1c) interrelationships in type 2 diabetes: implications for treatment and monitoring of metabolic control. Diabetes Care. 2001; 24:2023–9.

4. Monnier L, Lapinski H, Colette C. Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients: variations with increasing levels of HbA(1c). Diabetes Care. 2003; 26:881–5.

5. Riddle M, Umpierrez G, DiGenio A, Zhou R, Rosenstock J. Contributions of basal and postprandial hyperglycemia over a wide range of A1C levels before and after treatment intensification in type 2 diabetes. Diabetes Care. 2011; 34:2508–14.

6. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2004; 27(Suppl 1):S15–35.

7. Kikuchi K, Nezu U, Shirakawa J, Sato K, Togashi Y, Kikuchi T, et al. Correlations of fasting and postprandial blood glucose increments to the overall diurnal hyperglycemic status in type 2 diabetic patients: variations with levels of HbA1c. Endocr J. 2010; 57:259–66.

8. Wang JS, Tu ST, Lee IT, Lin SD, Lin SY, Su SL, et al. Contribution of postprandial glucose to excess hyperglycaemia in Asian type 2 diabetic patients using continuous glucose monitoring. Diabetes Metab Res Rev. 2011; 27:79–84.

9. Kametani T, Koshida H, Nagaoka T, Miyakoshi H. Hypertriglyceridemia is an independent risk factor for development of impaired fasting glucose and diabetes mellitus: a 9-year longitudinal study in Japanese. Intern Med. 2002; 41:516–21.

10. Lin SX, Berlin I, Younge R, Jin Z, Sibley CT, Schreiner P, et al. Does elevated plasma triglyceride level independently predict impaired fasting glucose?: the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2013; 36:342–7.

11. Bando Y, Ushiogi Y, Okafuji K, Toya D, Tanaka N, Fujisawa M. The relationship of fasting plasma glucose values and other variables to 2-h postload plasma glucose in Japanese subjects. Diabetes Care. 2001; 24:1156–60.

12. Munshi MN, Pandya N, Umpierrez GE, DiGenio A, Zhou R, Riddle MC. Contributions of basal and prandial hyperglycemia to total hyperglycemia in older and younger adults with type 2 diabetes mellitus. J Am Geriatr Soc. 2013; 61:535–41.

13. Chiu KC, Lee NP, Cohan P, Chuang LM. Beta cell function declines with age in glucose tolerant Caucasians. Clin Endocrinol (Oxf). 2000; 53:569–75.

14. Woerle HJ, Neumann C, Zschau S, Tenner S, Irsigler A, Schirra J, et al. Impact of fasting and postprandial glycemia on overall glycemic control in type 2 diabetes Importance of postprandial glycemia to achieve target HbA1c levels. Diabetes Res Clin Pract. 2007; 77:280–5.

15. Schernthaner G, Guerci B, Gallwitz B, Rose L, Nicolay C, Kraus P, et al. Impact of postprandial and fasting glucose concentrations on HbA1c in patients with type 2 diabetes. Diabetes Metab. 2010; 36:389–94.

16. Monnier L, Colette C, Dunseath GJ, Owens DR. The loss of postprandial glycemic control precedes stepwise deterioration of fasting with worsening diabetes. Diabetes Care. 2007; 30:263–9.