Cited by 362Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Treatment and ManagementDiabetes Management and Research

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Postprandial Glucose Regulation and Diabetic Complications

Ceriello, Antonio·2004·Archives of Internal Medicine

DOI 10.1001/archinte.164.19.2090

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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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“…also has significant shortcomings, including its relative insensitivity to glycemic fluctuations (Beisswenger et al. 2001; Rohlfing et al. 2002; Ceriello et al. 2004; Monnier and Colette 2006), and the inability of this early chemical reaction product (Amadori product) to detect variable…”
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Randomized Forced Titration to Different Doses of Technosphere® Insulin Demonstrates Reduction in Postprandial Glucose Excursions and Hemoglobin A1c in Patients with Type 2 Diabetes
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Background
Low and exacerbated levels of 1,5-anhydroglucitol are associated with cardiovascular events in patients after first-time elective percutaneous coronary intervention
Takahashi, S., Shimada, K., Miyauchi, K., Miyazaki, T., Sai, E., Ogita, M., Tsuboi, S., Tamura, H., Okazaki, S., Shiozawa, T., et al. (2016) · Cardiovascular Diabetology · doi:10.1186/s12933-016-0459-5 · Cited by 22
Short-term, but not acute, intake of New Zealand blackcurrant extract improves insulin sensitivity and free-living postprandial glucose excursions in individuals with overweight or obesity
NOLAN, A. M., Brett, R., Strauss, J. A., Stewart, C. E., & Shepherd, S. O. (2020) · European Journal of Nutrition · doi:10.1007/s00394-020-02329-7 · Cited by 22
Pramlintide reduced markers of oxidative stress in the postprandial period in patients with type 2 diabetes
Ceriello, A., Lush, C. W., Darsow, T., Piconi, L., Corgnali, M., Nanayakkara, N., Frías, J. P., & Maggs, D. G. (2007) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.765 · Cited by 22
“Postprandial hyperglycaemia, through the generation of oxidative stress and other injurious processes, is increasingly recognized as an important factor in the pathogenesis of these complications [3].”
BackgroundSelf-citation
Dietary carbohydrate intake and cardio-metabolic risk factors in type 1 diabetes
Ahola, A. J., Forsblom, C. M., Harjutsalo, V., & Groop, P. (2019) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2019.107818 · Cited by 21
“Importantly, dietary carbohydrates contribute to postprandial glycaemia, which is a major determinant of, not only long-term glycaemia [5], but also of macrovascular complications and mortality [6].”
Background
Efficacy and safety of evogliptin treatment in patients with type 2 diabetes: A multicentre, active‐controlled, randomized, double‐blind study with open‐label extension (the EVERGREEN study)
Kim, G., Lim, S. K., Kwon, H., Park, I. B., Ahn, K. J., Park, C., Kwon, S. K., Kim, H. S., Park, S. W., Kim, S. G., et al. (2020) · Diabetes Obesity and Metabolism · doi:10.1111/dom.14061 · Cited by 21
“It can lead to the development and progression of diabetic complications.(35) In this study, evogliptin treatment showed significant decreases in oxidative stress markers, nitrotyrosine and TBARS, accompanied by an attenuation of glycaemic variability mainly derived from postprandial glucose control.”
Background
Incretin-Based Therapies
Drucker, D. J. (2006) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721706287651 · Cited by 21
“tion and stroke.(10,11) Furthermore, many patients who have A1C levels within the target range still may have elevated postprandial hyperglycemia.”
Background
Effects of a Structured Self-Monitoring of Blood Glucose Method on Patient Self-Management Behavior and Metabolic Outcomes in Type 2 Diabetes Mellitus
Khamseh, M. E., Ansari, M., Malek, M., Shafiee, G., & Baradaran, H. (2011) · Journal of Diabetes Science and Technology · doi:10.1177/193229681100500228 · Cited by 20
A new animal model of insulin-glucose dynamics in the intraperitoneal space enhances closed-loop control performance
Chakrabarty, A., Gregory, J. M., Moore, L. M., Williams, P. E., Farmer, B., Cherrington, A. D., Lord, P., Shelton, B., Cohen, D., Zisser, H., et al. (2019) · Journal of Process Control · doi:10.1016/j.jprocont.2019.01.002 · Cited by 21
“The favorable pharmacokinetic-pharmacodynamic profile associated with intraperitoneal insulin delivery provides a practical approach for fully closed-loop systems to normalize postprandial hyperglycemia, a prominent contributor to overall hyperglycemia[57] and cardiovascular complications[58] in T1DM.”
Background
A dysregulation of glucose metabolism control is associated with carotid atherosclerosis in patients with coronary heart disease (CORDIOPREV-DIAB study)
Yubero‐Serrano, E. M., Delgado‐Lista, J., Alcala-Diaz, J. F., García‐Ríos, A., Pérez-Caballero, A. I., Blanco-Rojo, R., Gómez-Delgado, F., Marı́n, C., Tinahones, F. J., Caballero‐Villarraso, J., et al. (2016) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2016.07.903 · Cited by 20
Postprandial Glucose Surges after Extremely Low Carbohydrate Diet in Healthy Adults
Kanamori, K., Ihana‐Sugiyama, N., Yamamoto‐Honda, R., Nakamura, T., Sobe, C., Kamiya, S., Kishimoto, M., Kajio, H., Kawano, K., & Noda, M. (2017) · The Tohoku Journal of Experimental Medicine · doi:10.1620/tjem.243.35 · Cited by 20
“Postprandial hyperglycemia has been reported to be a risk factor for cardiovascular events in non-diabetic patients (Tominaga et al. 1999) as well as diabetic patients (Ceriello et al. 2004).”
Background
Association Between Insulin Resistance, Oxidative Stress, Sympathetic Activity and Coronary Microvascular Function in Patients With Early Stage Impaired Glucose Metabolism
Takei, Y., Tomiyama, H., Tanaka, N., Yamashina, A., & Chikamori, T. (2021) · Circulation Journal · doi:10.1253/circj.cj-21-0549 · Cited by 19
Effective Use of Paired Testing in Type 2 Diabetes
Parkin, C. G., Hinnen, D. A., Campbell, R. K., Geil, P., Tetrick, D. L., & Polonsky, W. H. (2009) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721709347601 · Cited by 19
Improved glycemic control induced by both metformin and repaglinide is associated with a reduction in blood levels of 3-deoxyglucosone in nonobese patients with type 2 diabetes
Engelen, L., Lund, S. S., Ferreira, I., Tarnow, L., Parving, H., Gram, J., Winther, K., Pedersen, O. B., Teerlink, T., Barto, R., et al. (2011) · European Journal of Endocrinology · doi:10.1530/eje-10-0851 · Cited by 19
Effects of Exercise Training and IL-6 Receptor Blockade on Gastric Emptying and GLP-1 Secretion in Obese Humans: Secondary Analyses From a Double Blind Randomized Clinical Trial
Lehrskov, L. L., Christensen, R. H., Wedell‐Neergaard, A., Legaard, G. E., Dorph, E., Larsen, M. K., Henneberg, M., Launbo, N., Fagerlind, S. R., Seide, S. K., et al. (2019) · Frontiers in Physiology · doi:10.3389/fphys.2019.01249 · Cited by 19
“Postprandial glucose levels are important for glycated hemoglobin (HbA1c) (Ceriello et al., 2004) emphasizing the relevance of in-depth understanding of the physiological regulators of gastric emptying.”
Background
Epidemiology and Risk Factors of Cardiovascular Disease in Postmenopausal Women
Gorodeski, E. Z., & Gorodeski, G. I. (2007) · Elsevier eBooks · doi:10.1016/b978-012369443-0/50039-9 · Cited by 19
Vinegar co-ingestion does not improve oral glucose tolerance in patients with type 2 diabetes
van Dijk, J.-W., Tummers, K., Hamer, H. M., & van Loon, L. J. C. (2012) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2012.05.009 · Cited by 18
Dichotomous responses of inter and postprandial hyperglycaemia to short‐term calorie restriction in patients with type 2 diabetes
Colette, C., Ginet, C., Boegner, C., Bénichou, M., Pham, T. C., Cristol, J., & Monnier, L. (2005) · European Journal of Clinical Investigation · doi:10.1111/j.1365-2362.2005.01482.x · Cited by 18
A Treatment to Cure Diabetes Using Plant-Based Drug Discovery
Mahankali, S., Kalava, J., Garapati, Y., Domathoti, B., Maddumala, V. R., & Sundramurthy, V. P. (2022) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2022/8621665 · Cited by 19
Efficacy of Postprandial Exercise in Mitigating Glycemic Responses in Overweight Individuals and Individuals with Obesity and Type 2 Diabetes—A Systematic Review and Meta-Analysis
Kang, J., Fardman, B., Ratamess, N. A., Faigenbaum, A. D., & Bush, J. A. (2023) · Nutrients · doi:10.3390/nu15204489 · Cited by 19
“Persistent postprandial hyperglycemia is an important risk factor for type 2 diabetes mellitus (T2DM) and its complications, which include cardiovascular diseases and mortality [1–3].”
Background
Vascular Effects of Dietary Advanced Glycation End Products
Stirban, A. O., & Tschöpe, D. (2015) · International Journal of Endocrinology · doi:10.1155/2015/836498 · Cited by 18
“Themechanisms that link postprandial dysmetabolism to CVD might be the exacerbation of oxidative stress and the occurrence of endothelial dysfunction [25–27].”
Background
Association of glycated albumin with the presence of carotid plaque in patients with type 2 diabetes
Sato, Y., Nagao, M., Asai, A., Nakajima, Y., Takaya, M., Takeichi, N., Takemitsu, S., Sudo, M., Kano‐Wakakuri, T., Ishizaki, A., et al. (2013) · Journal of Diabetes Investigation · doi:10.1111/jdi.12085 · Cited by 17
“016 Antiplatelet agent (n [%]) 26 [11] 23 [15] 3 [4] 0.”
Impact of Glucose Fluctuation on Acute Cerebral Infarction in Type 2 Diabetes
Huang, J., Zhang, X., Li, J., Tang, L., Jiao, X., & Lv, X. (2014) · Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques · doi:10.1017/s0317167100018539 · Cited by 17
Basal insulin combined incretin mimetic therapy with glucagon-like protein 1 receptor agonists as an upcoming option in the treatment of type 2 diabetes: a practical guide to decision making
Scholz, G. H., & Fleischmann, H. (2014) · Therapeutic Advances in Endocrinology and Metabolism · doi:10.1177/2042018814556099 · Cited by 16
“Some studies also confirmed that postprandial hyperglycemia is an independent cardiovascular risk factor whether or not these studies are based on 2 h glucose levels after oral glucose tolerance test or after meal challenge tests [Hanefeld et al. 2000; Balkau et al. 2004; Ceriello et al. 2004; Cavalot et al. 2006, 201…”
Background
Effect of glycemic control on markers of subclinical atherosclerosis in patients with type 2 diabetes mellitus: A review
Antoniou, S., Naka, K. Κ., Papadakis, M., Bechlioulis, A., Tsatsoulis, A. A., Michalis, L. K., & Tigas, S. K. (2021) · World Journal of Diabetes · doi:10.4239/wjd.v12.i11.1856 · Cited by 19
Antihyperglycemic potential of the Lavandula stoechas aqueous extract via inhibition of digestive enzymes and reduction of intestinal glucose absorption
Elrherabi, A., Bouhrim, M., Abdnim, R., Berraaouan, A., Ziyyat, A., Mekhfi, H., Legssyer, A., & Bnouham, M. (2023) · Journal of Ayurveda and Integrative Medicine · doi:10.1016/j.jaim.2023.100795 · Cited by 16
“Among the therapies used to decrease postprandial hyperglycemia, responsible for the chronic complication presence, are digestive enzymes (a-amylase and aglucosidase) inhibition linked to diabetes, and glucose intestinal absorption reduction [5].”
Background
Consumption of the Soluble Dietary Fibre Complex PolyGlycopleX® Reduces Glycaemia and Increases Satiety of a Standard Meal Postprandially
Solah, V. A., O’Mara-Wallace, B., Meng, X., Gahler, R. J., Kerr, D. A., James, A. P., Fenton, H., Johnson, S. K., & Wood, S. (2016) · Nutrients · doi:10.3390/nu8050268 · Cited by 15
“The management and prevention of impaired glucose tolerance and type 2 diabetes requires the avoidance of postprandial “spikes” and a more gradual drop of blood glucose over time [42], thus the postprandial response for PGX indicates its potential benefits in relation to type 2 diabetes prevention and management.”
Background
Effect of low dose mineralocorticoid receptor antagonist eplerenone on glucose and lipid metabolism in healthy adult males
Krug, A. W., Stelzner, L., Rao, A. D., Lichtman, A. H., Williams, G. H., & Adler, G. K. (2012) · Metabolism · doi:10.1016/j.metabol.2012.08.011 · Cited by 15
“The adverse cardiovascular effects of elevated plasma glucose levels in diabetes patients are well known [7,8].”
Continuous Glucose Monitoring Reveals Different Glycemic Responses of Moderate- vs High-Carbohydrate Lunch Meals in People with Type 2 Diabetes
Powers, M. A., Cuddihy, R. M., Wesley, D., & Morgan, B. (2010) · Journal of the American Dietetic Association · doi:10.1016/j.jada.2010.09.010 · Cited by 15
Targeting prandial hyperglycemia: How important is it and how best to do this?
Monnier, L., & Colette, C. (2008) · Current Diabetes Reports · doi:10.1007/s11892-008-0064-4 · Cited by 15
Comparison between a multiple daily insulin injection regimen (basal once-daily glargine plus mealtime lispro) and continuous subcutaneous insulin infusion (lispro) using continuous glucose monitoring in metabolically optimized type 1 diabetes patients: A randomized open-labelled parallel study
Ruiz-de-Adana, M. S., Dominguez-Lopez, M.-E., González-Molero, I., Machado, A., Martin, V., Cardona, I., de la Higuera, M., Tapia, M. J., Soriguer, F., Ortiz, M. T. A., et al. (2015) · Medicina Clínica · doi:10.1016/j.medcli.2015.09.020 · Cited by 15
Effects of biphasic, basal-bolus or basal insulin analogue treatments on carotid intima-media thickness in patients with type 2 diabetes mellitus: the randomised Copenhagen Insulin and Metformin Therapy (CIMT) trial
Lundby‐Christensen, L., Vaag, A. A., Tarnow, L., Almdal, T., Lund, S. S., Wetterslev, J., Gluud, C. N., Boesgaard, T. W., Wiinberg, N., Perrild, H., et al. (2016) · BMJ Open · doi:10.1136/bmjopen-2015-008377 · Cited by 15
Continuous glucose monitoring in type 2 diabetes
Harman‐Boehm, I. (2008) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2008.09.051 · Cited by 15
“Thus, postprandial glucose surges may favor the onset and progression of diabetic complications [27,28].”
BackgroundInfluential
Effects of Acarbose on the Acceleration of Postprandial Hyperglycemia–Induced Pathological Changes Induced by Intermittent Hypoxia in Lean Mice
Miyamura, M., Schnell, O., Yamashita, C., Yoshioka, T., Matsumoto, C., Mori, T., Ukimura, A., Kitaura, Y., Matsumura, Y., Ishizaka, N., et al. (2010) · Journal of Pharmacological Sciences · doi:10.1254/jphs.10014fp · Cited by 15
Predicting postprandial glucose excursions to personalize dietary interventions for type-2 diabetes management
Brügger, V., Kowatsch, T., & Jovanova, M. (2025) · Scientific Reports · doi:10.1038/s41598-025-08003-4 · Cited by 19
An assessment of the interaction for three Chrysanthemum indicum flavonoids and α‐amylase by surface plasmon resonance
Li, P., Huang, Z., She, Y., Qin, S., Gao, W., Cao, Y., & Liu, X. (2019) · Food Science & Nutrition · doi:10.1002/fsn3.1349 · Cited by 13
Weight Management in Type 2 Diabetes Mellitus
Siram, A. T., Yanagisawa, R. T., & Skamagas, M. (2010) · Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine · doi:10.1002/msj.20208 · Cited by 15
Relationship between postprandial glucose level and carotid artery stiffness in patients without diabetes or cardiovascular disease
Watanabe, K., Suzuki, T., Ouchi, M., Suzuki, K., Ohara, M., Hashimoto, M., Yamashita, H., Okazaki, M., Ishii, K., & Oba, K. (2013) · BMC Cardiovascular Disorders · doi:10.1186/1471-2261-13-11 · Cited by 14
“Furthermore, in persons with impaired glucose tolerance (IGT), postprandial hyperglycemia, but not fasting hyperglycemia, increases the risk of cardiovascular disease [2].”
Background
Pharmacokinetic evaluation of atorvastatin and sitagliptin in combination for the treatment of type 2 diabetes
Scheen, A. J. (2012) · Expert Opinion on Drug Metabolism & Toxicology · doi:10.1517/17425255.2012.686603 · Cited by 13
“Besides fasting glycemia, most epidemiological data also implicate postprandial hyperglycemia in the development of CVD, suggesting that glucose-lowering agents should also tackle postmeal hyperglycemia [12].”
Background
Making sense of glucose metrics in diabetes: linkage between postprandial glucose (PPG), time in range (TIR) & hemoglobin A1c (A1C)
Martens, T. W., Bergenstal, R. M., Pearson, T. L., Carlson, A. L., Scheiner, G., Carlos, C., Liao, B., Syring, K. E., & Pollom, R. D. (2020) · Postgraduate Medicine · doi:10.1080/00325481.2020.1851946 · Cited by 13

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)
DOI: 10.1001/archinte.164.19.2090
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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Postprandial Glucose Regulation and Diabetic Complications

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