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Postprandial Glucose Regulation and Diabetic Complications
Abstract
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 (HbA(1c)) 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 HbA(1c) 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.
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“Postprandial hypertriglyceridemia and hyperglycemia are considered risk factors for cardiovascular disease.”
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“Because postprandial state is a risk factor for CVD even in diabetic patients, [1][2][3]”
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“Additionally, postprandial hyperglycemia has been shown to be a more powerful predictor of diabetic complications than glycosylated hemoglobin (HbA1c) and fasting hyperglycemia alone [24].”
BackgroundImportance of Postprandial Glucose in Relation to A1C and Cardiovascular Disease
Hershon, K. S., Hirsch, B. R., & Odugbesan, O. (2019) · Clinical Diabetes · doi:10.2337/cd18-0040 · Cited by 62
“Studies have shown that, in addition to its contribution to overall A1C, PPG is an independent risk factor for CVD, with a demonstrated linear relationship of PPG and risk of cardiovascular (CV) death (13).”
BackgroundBasal insulin or premix analogue therapy in type 2 diabetes patients
Raskin, P., Hollander, P. A., Lewin, A. J., Gabbay, R. A., Bode, B. W., & Garber, A. J. (2007) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2006.09.006 · Cited by 55
“Although not yet confirmed by prospective intervention trials, as recently reviewed by several authors, numerous observational studies have demonstrated that improved control of postprandial glucose is statistically associated with a significantly decreased risk of macrovascular [7–10] and microvascular [11] complicat…”
BackgroundResultZheng, F., Lu, W., Jia, C., Li, H., Wang, Z., & Jia, W. (2010) · Endocrine · doi:10.1007/s12020-009-9296-6 · Cited by 55
“The condition of chronic hyperglycemia can present in two different forms: sustained hyperglycemia and fluctuating hyperglycemia [ 4 , 5]. Glycated hemoglobin (HbA1c), an indicator of chronic sustained hyperglycemia, is the standard by which glycemic control is measured.”
BackgroundOuassou, H., Zahidi, T., Bouknana, S., Bouhrim, M., Mekhfi, H., Ziyyat, A., Legssyer, A., Aziz, M., & Bnouham, M. (2018) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2018/9589472 · Cited by 54
“Most epidemiological data implicate postprandial hyperglycemia in the development of chronic complications [8].”
BackgroundBonomo, K., De Salve, A., Fiora, E., Mularoni, E., Massucco, P., Poy, P., Pomero, A., Cavalot, F., Anfossi, G., & Trovati, M. (2010) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2009.10.021 · Cited by 53
Nesti, L., Mengozzi, A., & Tricò, D. (2019) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00144 · Cited by 53
Santos‐Oliveira, R., Purdy, C., da Silva, M. P., Carneiro-Leão, A. M. D. A., Machado, M., & Einarson, T. R. (2011) · Diabetologia · doi:10.1007/s00125-011-2078-8 · Cited by 51
“However, despite the increasing number of studies of glycaemic control and CVEs, few have examined that relationship in persons without diabetes [1–8].”
BackgroundLaaraj, N., Bouhrim, M., Kharchoufa, L., Tiji, S., Bendaha, H., Addi, M., Drouet, S., Hano, C., Lorenzo, J. M., Bnouham, M., et al. (2022) · Foods · doi:10.3390/foods11091353 · Cited by 56
“One of the treatments for decreasing postprandial hyperglycemia is related to the inhibition of digestive enzymes and the reduction in glucose intestinal absorption [5].”
BackgroundExploring the Variability in Acute Glycemic Responses to Exercise in Type 2 Diabetes
Terada, T., Friesen, A., Chahal, B. S., Bell, G. J., McCargar, L. J., & Boulé, N. G. (2013) · Journal of Diabetes Research · doi:10.1155/2013/591574 · Cited by 53
“Given the possible pathogenic role postprandial hyperglycemia plays on the risk of diabetic complications [24, 25], performing exercise within 2 hours ofmeal intakemay be a good strategy to attenuate meal-induced hyperglycemia.”
BackgroundDietary Glycemic Load Is a Predictor of Age-Related Hearing Loss in Older Adults ,
Gopinath, B., Flood, V. M., McMahon, C. M., Burlutsky, G., Brand-Miller, J. C., & Mitchell, P. L. R. (2010) · Journal of Nutrition · doi:10.3945/jn.110.128462 · Cited by 50
Pistrosch, F., Reissmann, E., Wildbrett, J., Koehler, C., & Hanefeld, M. (2007) · American Journal of Hypertension · doi:10.1016/j.amjhyper.2006.10.010 · Cited by 49
Hinzmann, R., Schlaeger, C., & Tran, C. T. (2012) · International Journal of Medical Sciences · doi:10.7150/ijms.4520 · Cited by 51
“The exposure to elevated blood glucose levels in people with diabetes involves two components: the duration and magnitude of chronically sustained hyperglycemia, reflected in HbA1c, and the acute fluctuations of glucose around a mean value from peaks to nadirs over a daily period [69-73], reflecting intermittent acute…”
BackgroundPeak-time determination of post-meal glucose excursions in insulin-treated diabetic patients
Daenen, S., Sola‐Gazagnes, A., M’Bemba, J., Dorange-Breillard, C., Defer, F., Elgrably, F., Larger, É., & Slama, G. (2010) · Diabetes & Metabolism · doi:10.1016/j.diabet.2009.12.002 · Cited by 49
Point: Postprandial Glucose Levels Are a Clinically Important Treatment Target
Ceriello, A. (2010) · Diabetes Care · doi:10.2337/dc10-0634 · Cited by 51
“pothesis (11), including the recent data of”
BackgroundSelf-citationBreyton, A.-E., Lambert-Porcheron, S., Laville, M., Vinoy, S., & Nazare, J. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.666008 · Cited by 48
Insulin Aspart in the Management of Diabetes Mellitus: 15 Years of Clinical Experience
Hermansen, K., Bohl, M., & Schioldan, A. G. (2015) · Drugs · doi:10.1007/s40265-015-0500-0 · Cited by 47
“Some studies have indicated that postprandial glucose is a predictor of CVD or mortality independent of fasting glucose levels [19–24]; however, the current evidence for this is still highly controversial [25].”
BackgroundGhanim, H., Batra, M., Abuaysheh, S., Green, K., Makdissi, A., Kuhadiya, N. D., Chaudhuri, A., & Dandona, P. (2017) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-2669 · Cited by 46
Piątkowska‐Chmiel, I., Herbet, M., Gawrońska‐Grzywacz, M., Ostrowska-Leśko, M., & Dudka, J. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22083878 · Cited by 46
“High fasting glucose and insulin levels and high HOMA-IR index didn’t only confirm effective induction of experimental type 2 diabetes but also made it possible to observe CNS dysfunction widely described in the literature [6,7,11,13,49].”
BackgroundLiao, Y., Takashima, S., ZHAO, H., ASANO, Y., Shintani, Y., Minamino, T., KIM, J., Fujita, M., HORI, M., & Kitakaze, M. (2006) · Cardiovascular Research · doi:10.1016/j.cardiores.2006.01.021 · Cited by 45
Walsh, L. K., Restaino, R. M., Neuringer, M., Manrique, C. M., & Padilla, J. (2016) · Clinical Science · doi:10.1042/cs20160501 · Cited by 43
“It is well established that hyperglycemia is a major underlying contributor to cardiovascular disease (3, 12, 13, 14, 41, 51, 60, 63).”
BackgroundCardiac cell death in early diabetes and its modulation by dietary fatty acids
Ghosh, S., & Rodrigues, B. B. (2006) · Biochimica et Biophysica Acta (BBA) - Molecular and Cell Biology of Lipids · doi:10.1016/j.bbalip.2006.08.010 · Cited by 43
Exercise-nutrient interactions for improved postprandial glycemic control and insulin sensitivity
Gillen, J. B., Estafanos, S., & Govette, A. (2021) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2021-0168 · Cited by 52
Diabetic Gastroparesis and Its Impact on Glycemia
Chang, J., Rayner, C. K., Jones, K. L., & Horowitz, M. (2010) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2010.08.007 · Cited by 43
Glycation and biomarkers of vascular complications of diabetes
Beisswenger, P. J. (2010) · Amino Acids · doi:10.1007/s00726-010-0784-z · Cited by 42
Kumar, S., & Sandhya, A. S. (2017) · Indian Heart Journal · doi:10.1016/j.ihj.2017.10.007 · Cited by 43
Metadata
- Authors
- Ceriello, A.
- Affiliations
- University of Udine (IT)
- Corresponding author
- Ceriello, Antonio
- ORCID
- Ceriello, Antonio
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2004-10-25
- Volume
- 164
- Issue
- 19
- Pages
- 2090
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2037632798
- Cited by
- 362
- References
- 52
- Citations by year
- 2026: 7 · 2025: 16 · 2024: 8 · 2023: 10 · 2022: 13 · 2021: 15 · 2020: 12 · 2019: 19 · 2018: 15 · 2017: 12 · 2016: 22 · 2015: 15 · 2014: 11 · 2013: 19 · 2012: 23
- FWCI
- 12.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System (University of Udine) (submittedVersion)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- postprandial blood glucose, postprandial hyperglycemia, type 2 diabetes, cardiovascular complications, atherosclerosis, glycemic control, HbA1c, oxidative stress, endothelial cell cytotoxicity, glycemic exposure, cardiovascular risk prediction
- MeSH terms
- Blood Glucose, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Postprandial Period, Diabetes Complications
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