Postprandial glucose peaks in the pathogenesis of cardiovascular disease in diabetes mellitus; implications for metabolic control
Wolffenbuttel, B.H.R.
Nederlands Tijdschrift Voor Geneeskunde 146(14): 654-658
2002
ISSN/ISBN: 0028-2162 PMID: 11969032 Document Number: 541259
It has been shown both in type I and in type 2 diabetes that optimal glucose control retards the development of diabetes-related complications. The concentration of glycated haemoglobin (HbA1c) is a measure of metabolic control during the previous five weeks. Several studies have indicated that an elevated blood glucose level after an oral glucose tolerance test or after a meal (2-hour value: 7-11 mmol/l) is a better risk indicator for future cardiovascular disease and death than the level of fasting blood glucose or HbA1c. Increased glucose auto-oxidation, labile glycosylation and intracellular activation of the polyol pathway leading to increased oxidative stress are believed to play an important pathophysiological role. In addition, direct stimulatory effects of glucose on specific intracellular signalling peptides, such as protein kinase C, as well as a direct effect on the vessel walls also play a role. In future studies the challenge will be to demonstrate the specific effects of improved postprandial blood-glucose control, and to separate these out from the general effects of intensive therapy with oral medication and insulin on glucose control. People suffering from diabetes are best advised to direct their self control also at the bloodglucose level 1.5-2 h after a meal.