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Postprandial Glucose Regulation and Diabetic Complications
Antonio Ceriello, MD;
Markolf Hanefeld, MD, PhD;
Lawrence Leiter, MD, FRCPC, FACP;
Louis Monnier, MD;
Alan Moses, MD;
David Owens, MD;
Naoko Tajima, MD, PhD;
Jaakko Tuomilehto, MD, MPoLSc, PhD; for the International Prandial Glucose Regulation (PGR) Study Group
Arch Intern Med. 2004;164:2090-2095.
Atherosclerotic disease accounts for much of the increased mortality and morbidity associated with type 2 diabetes. Epidemiological studies support the potential of improved glycemic control to reduce cardiovascular complications. An association between glycosylated hemoglobin (HbA1c) level and the risk for cardiovascular complications has frequently been reported. Most epidemiological data implicate postprandial hyperglycemia in the development of cardiovascular disease, whereas the link between fasting glycemia and diabetic complications is inconclusive. Moreover, in many studies, postprandial glycemia is a better predictor of cardiovascular risk than HbA1c level. Postprandial glucose may have a direct toxic effect on the vascular endothelium, mediated by oxidative stress that is independent of other cardiovascular risk factors such as hyperlipidemia. Postprandial hyperglycemia also may exert its effects through its substantial contribution to total glycemic exposure. The present review examines the hypothesis that controlling postprandial glucose level is an important strategy in the prevention of cardiovascular complications associated with diabetes.
Author Affiliations: Department of Pathology and Medicine Experimental and Clinical, University of Udine, Udine, Italy (Dr Ceriello); Centre for Clinical Studies, Technical University, Dresden, Germany (Dr Hanefeld); Division of Endocrinology and Metabolism, St Michael’s Hospital, University of Toronto, Toronto, Ontario (Dr Leiter); Department of Metabolism, Lapeyronie Hospital, Montpellier, France (Dr Monnier); Joslin Diabetes Center, Boston, Mass (Dr Moses); Diabetes Research Unit Academic Centre, Llandough Hospital, Penarth, Wales (Dr Owens); Division of Diabetes and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan (Dr Tajima); and the Diabetes and Genetic Epidemiology Unit, National Public Health Institute, Helsinki, Finland (Dr Tuomilehto).
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