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Cited by 569Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Treatment and ManagementDiabetes Management and Research

Postprandial Blood Glucose Is a Stronger Predictor of Cardiovascular Events Than Fasting Blood Glucose in Type 2 Diabetes Mellitus, Particularly in Women: Lessons from the San Luigi Gonzaga Diabetes Study

Cavalot, F., Petrelli, A., Traversa, M., Bonomo, K., Fiora, E., Conti, M., Anfossi, G., Costa, G. +1 more·2006·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2005-1005
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Abstract

OBJECTIVE: The influence of postprandial blood glucose on diabetes complications is intensively debated. We aimed to evaluate the predictive role of both fasting and postprandial blood glucose on cardiovascular events in type 2 diabetes and the influence of gender. METHODS: In a population of 529 (284 men and 245 women) consecutive type 2 diabetic patients attending our diabetes clinic, we evaluated the relationships, corrected for cardiovascular risk factors and type of treatment, between cardiovascular events in a 5-yr follow-up and baseline values of hemoglobin A1c (HbA1c) and blood glucose measured: 1) after an overnight fast, 2) after breakfast, 3) after lunch, and 4) before dinner. Continuous variables were categorized into tertiles. RESULTS: We recorded cardiovascular events in 77 subjects: 54 of 284 men (19%) and 23 of 245 women (9.4%). Univariate analysis indicated that cardiovascular events were associated with increasing age, longer diabetes duration, and higher HbA1c and fibrinogen in men, and higher systolic blood pressure, albumin excretion rate, HbA1c, and all blood glucose values in women. Smoking was more frequent in subjects with events. When all blood glucose values and HbA1c were introduced simultaneously in the models, only blood glucose after lunch predicted cardiovascular events, with hazard ratio of the third tertile vs. the first and the second tertiles greater in women (5.54; confidence interval, 1.45-21.20) than in men (2.12; confidence interval, 1.04-4.32; P < 0.01). CONCLUSIONS: Postprandial, but not fasting, blood glucose is an independent risk factor for cardiovascular events in type 2 diabetes, with a stronger predictive power in women than in men, suggesting that more attention should be paid to postprandial hyperglycemia, particularly in women.

AI snapshot

Written from the paper’s full text.

TL;DR

In a 5-year follow-up of 529 type 2 diabetes patients, blood glucose measured after lunch independently predicted cardiovascular events, whereas fasting glucose did not. The predictive effect was stronger in women than in men.

Key findings

  • Cardiovascular events occurred in 77 participants: 54 of 284 men (19%) and 23 of 245 women (9.4%).
  • When all glucose measurements and HbA1c were included together, only post-lunch blood glucose remained a significant predictor of cardiovascular events.
  • The hazard ratio for the third tertile versus the first and second tertiles of post-lunch glucose was 5.54 (95% CI, 1.45–21.20) in women and 2.12 (95% CI, 1.04–4.32) in men; the gender difference was statistically significant (P < 0.01).
  • HbA1c correlated with all measured glucose values in both genders, but fasting glucose had low predictive value for events.

Methods

  • Prospective cohort study of 529 consecutive type 2 diabetes patients at an Italian diabetes clinic, enrolled in 1995 and followed through 2000.
  • Baseline assessment included cardiovascular risk factors, HbA1c, and glucose profiles: fasting, 2 hours after breakfast, 2 hours after lunch, and before dinner.
  • Cox proportional hazards models were fitted separately by gender, with glucose and HbA1c values categorized into tertiles and adjusted for age, diabetes duration, previous cardiovascular events, systolic blood pressure, albumin excretion rate, fibrinogen, smoking, and type of treatment.

Limitations

  • The paper states that a possible limitation is the limited number of cardiovascular events in women.
  • The text makes evident that glucose before lunch was unavailable for most patients, so lunch-induced glucose excursions could not be evaluated across the whole cohort.
  • Glucose profiles were measured either in hospital by nurses or at home by patients using a reflectance meter, which may introduce measurement variability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1210/jc.2005-1005

Cites

34 of 34 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 45 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § Results

    In men, among the single blood glucose measures, only post-lunch blood glucose was linked to a significantly higher risk of a first cardiovascular event when the third tertile was compared with the first and second tertiles, after adjustment for cardiovascular risk factors and treatment.

    “In men, when models were fitted with single BG values (models A-D) and the third tertile was compared with the first and the second tertiles, a significantly increased risk of cardiovascular events was observed only for BGAL.”
    Quote in the paperNot a substantial claim
  • Findingreasoning
    § Discussion

    In the present study, blood glucose after breakfast did not predict cardiovascular events.

    “BG after breakfast predicted cardiovascular events in the DIS, but not in our study”
    Quote in the paperNot a substantial claim
  • Findingown data
    § First Published Online December 13, 2005

    When all blood glucose values and HbA1c were entered together, only post-lunch glucose predicted cardiovascular events.

    “When all blood glucose values and HbA1c were introduced simultaneously in the models, only blood glucose after lunch predicted cardiovascular events”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The blood glucose profiles used at baseline reflect the patients' usual glycemic control.
  • Findingown data
    § Results

    In women, when all blood glucose values were considered together, only the hazard ratio for post-lunch blood glucose remained statistically significant, both without and with HbA1c in the models.

    “When all BG values were considered together, only HR for BGAL remained statistically significant both without and with the addition of HbA1c in the models (model E and J).”
    Quote in the paperSubstantial claim
  • Findingown data
    § Results

    Men with and without cardiovascular events differed in age, diabetes duration, previous cardiovascular events, fibrinogen, and HbA1c.

    “Men without and with cardiovascular events differed for age, known diabetes duration, previous cardiovascular events, fibrinogen, and HbA1c”
    Quote in the paperNot a substantial claim
  • May combine two claims. 19
  • Classified as probably not a substantial claim. 27

  • May combine two claims.

    Findingown data
    § Results

    In women, when each blood glucose value was considered separately, hazard ratios for fasting blood glucose, post-lunch blood glucose, and post-dinner blood glucose were significant; these results held when HbA1c was included.

    “In women, when each BG value was considered independently of the others (models A-D), HR for FBG, BGAL, and BGBD were significant; the results were confirmed when HbA1c was included in the models (models F-I).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Results

    HbA1c correlated with all blood glucose values in both men and women.

    “HbA1c was correlated ( P &lt; 0.0001) with all BG values in both men and women.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Results

    In pooled multiple regression, all glucose values remained significantly correlated with HbA1c (FBG r=0.104, P<0.046; BGAB r=0.216, P<0.0001; BGAL r=0.229, P<0.0001; BGBD r=0.097, P=0.049).

    “When HbA1c and BG values from both genders were pooled together, multiple regression analysis showed that all values remained significantly correlated with HbA1c (r = 0.104, P &lt; 0.046 for FBG; r = 0.216, P &lt; 0.0001 for BGAB; r = 0.229, P &lt; 0.0001 for BGAL; and r = 0.097, P = 0.049 for BGBD).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    Women with and without cardiovascular events differed in previous cardiovascular events, systolic blood pressure, AER, HbA1c, and all blood glucose values.

    “women differed for previous cardiovascular events, systolic blood pressure, AER, HbA1c, and all BG”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Results

    At baseline, men and women differed significantly in age, diabetes duration, previous cardiovascular events, smoking, hypoglycemic therapy, BMI, total/HDL cholesterol ratio, fibrinogen, AER, and HbA1c.

    “Men and women differed significantly for age, diabetes duration, previous cardiovascular events, smoking habit, hypoglycemic therapy, BMI, total/HDL cholesterol ratio, fibrinogen, AER, and HbA1c.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data
    § Results

    Among the 77 cardiovascular events, 38 (49.3%) were coronary, 26 (33.8%) cerebrovascular, and 13 (16.9%) peripheral vascular.

    “38 of 77 (49.3%) were coronary (29 in men and nine in women), 26 of 77 (33.8%) were cerebrovascular (14 in men and 12 in women), and 13 of 77 (16.9%) were peripheral vascular (11 in men and two in women).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Record linkage with hospital discharge and population registers accurately identifies cardiovascular events and deaths.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data
    § Results

    Twenty-three participants died: five from cardiovascular causes, 10 from cancer, and eight from other causes; two deaths from cancer or other causes were preceded by a cardiovascular event.

    “Twenty-three participants died: five from cardiovascular events, 10 from neoplasia, and eight from other reasons; death was preceded by a cardiovascular event in two subjects who died from neoplasia or other causes.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Record linkage with hospital discharge and population registers accurately identifies cardiovascular events and deaths.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Results

    Cardiovascular events occurred in 77 patients: 54 of 284 men (19%) and 23 of 245 women (9.4%).

    “We recorded cardiovascular events in 77 patients, 54 in 284 men (19%) and 23 in 245 women (9.4%)”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Record linkage with hospital discharge and population registers accurately identifies cardiovascular events and deaths.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Results

    When men and women were pooled, smoking habit was significantly associated with cardiovascular events (χ2=7.8; P=0.02).

    “When both men and women were pooled together, the effect of smoking habit was significant ( 𝛘 2 = 7.8; P = 0.02).”
    • Also stated in: § First Published Online December 13, 2005 · plain
      “Smoking was more frequent in subjects with events.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    Blood glucose after lunch was higher than after breakfast (P=0.02 in men, P=0.007 in women), with larger differences in patients who had events.

    “BGAL was higher than BGAB ( P = 0.02 in men and P = 0.007 in women; Table 1), with greater differences in patients with events (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    Correlation coefficients between HbA1c and fasting, post-breakfast, post-lunch, and pre-dinner glucose were 0.388, 0.425, 0.483, and 0.390 in men and 0.452, 0.512, 0.458, and 0.421 in women.

    “linear correlation coefficients between HbA1c and FBG, BGAB, BGAL, and BGBD were, respectively, in men, r = 0.388, r = 0.425, r = 0.483, and r = 0.390; and in women, r = 0.452, r = 0.512, r = 0.458, and r = 0.421.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § First Published Online December 13, 2005

    The hazard ratio for the top tertile versus the lower two tertiles of post-lunch glucose was 5.54 (CI 1.45-21.20) in women and 2.12 (CI 1.04-4.32) in men, with a significant sex difference (P<0.01).

    “with hazard ratio of the third tertile vs. the first and the second tertiles greater in women (5.54; confidence interval, 1.45-21.20) than in men (2.12; confidence interval, 1.04-4.32; P < 0.01).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The blood glucose profiles used at baseline reflect the patients' usual glycemic control.

  • May combine two claims.

    Findingown data
    § Results

    In model J, the hazard ratio for post-lunch blood glucose was higher in women (5.54; 95% CI 1.45-21.20) than in men (2.12; 95% CI 1.04-4.32), and the difference between genders was statistically significant (P < 0.01).

    “In model J, HR for BGAL was greater in women (5.54; confidence interval, 1.45-21.20) than in men (2.12; confidence interval, 1.04-4.32; for the difference between genders, P &lt; 0.01).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Results

    In men, the link between post-lunch blood glucose and cardiovascular events stayed significant when all blood glucose values were included together (model E) or when HbA1c was added (model H).

    “The association of cardiovascular events with BGAL remained significant when all BG values were added together (model E) or when HbA1c was added (model H).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data
    § Discussion

    Men in the study had a more frequent smoking habit, greater total/HDL cholesterol ratio and AER, and a more frequent history of previous cardiovascular events than women.

    “whereas men presented a more frequent smoking habit, greater total/HDL cholesterol ratio and AER, and a more frequent history of previous cardiovascular events.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Discussion

    Fasting blood glucose and HbA1c had low predictive value for cardiovascular events in the present analysis.

    “In contrast, when we tried to determine the predictive role of each component of BG control, we observed a low predictive value of FBG and HbA1c, in agreement with other observations concerning the prediction of atherosclerosis in subjects at risk for type 2 diabetes mellitus (33).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] 33. Temelkova-Kurktschiev T, Koehler C, Henkel E, Leonhardt W, Fuecker K, Hanefeld M 2000 Postchallenge plasma glucose and glycemic spikes are more strongly associated with atherosclerosis than fasting glucose or HbA1c level. Diabetes Care 23:1830-1834

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data
    § Discussion

    Women in the study were older, had longer diabetes duration, and had greater BMI, HbA1c, and fibrinogen values than men.

    “women were older, had a longer diabetes duration, and had greater BMI, HbA1c and fibrinogen values”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Discussion

    The hazard ratio for cardiovascular events conferred by post-lunch blood glucose was 5.54 in women versus 2.12 in men, and the difference was statistically significant.

    “In particular, HR for cardiovascular events conferred by postlunch BG was 5.54 in women vs. 2.12 in men, the difference being statistically significant.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation
    § First Published Online December 13, 2005

    Studies mostly in general populations indicate that glucose measured after a challenge predicts cardiovascular events and death better than fasting glucose.

    “predicts the incidence of cardiovascular events and mortality more than fasting BG”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [13] 13. Haffner S 1998 The importance of hyperglycemia in the non fasting state to the development of cardiovascular disease. Endocr Rev 19:583-592

      Not checked in the free run.

    • cites [14] 14. Bonora E, Muggeo M 2001 Postprandial blood glucose as a risk factor for cardiovascular disease in type 2 diabetes: the epidemiological evidence. Diabetologia 44:2107-2114

      Not checked in the free run.

    • cites [15] 15. Heine RJ, Dekker JM 2002 Beyond postprandial hyperglycaemia: metabolic factors associated with cardiovascular disease. Diabetologia 45:461-475

      Not checked in the free run.

    • cites [16] 16. Gerich JE 2003 Clinical significance, pathogenesis and management of postprandial hyperglycemia. Arch Intern Med 163:1306-1316

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation
    § Subjects and Methods

    The Reflolux II reflectance meter used in hospital and at home had previously documented reliability in the authors' laboratory.

    “the reflectance meter used both in the hospital and at home was Reflolux II (Roche, Mannheim, Germany), whose reliability in our laboratory has been previously described (27).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] 27. Trovati M, Burzacca S, Mularoni E, Massucco P, Cavalot F, Mattiello L, Anfossi G 1991 Occurrence of low blood glucose concentrations during the afternoon in type 2 (non-insulin-dependent) diabetic patients on oral hypoglycaemic agents: importance of blood glucose monitoring. Diabetologia 34:662-667

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data
    § Discussion

    The paper's main conclusion is that blood glucose after lunch predicts cardiovascular events over a 5-year follow-up in type 2 diabetic patients more than fasting blood glucose, and that this effect is stronger in women than in men.

    “The main messages of this paper are that BG after lunch predicts the occurrence of cardiovascular events in a 5-yr follow-up in type 2 diabetic patients more than fasting BG, and that this effect is stronger in women than in men.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Postprandial Blood Glucose Is a Stronger Predictor of Cardiovascular Events Than Fasting Blood Glucose in Type 2 Diabetes Mellitus, Particularly in Women: Lessons from the San Luigi Gonzaga Diabetes Study

    Type 2 diabetes patients have higher cardiovascular illness and death rates.

    “P ATIENTS AFFECTED BY type 2 diabetes show an increased cardiovascular morbidity and mortality (1, 2).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] 1. Laakso M, Lehto S 1997 Epidemiology of macrovascular disease in diabetes. Diabetes Rev 5:294-315

      Not checked in the free run.

    • cites [2] 2. Stamler J, Vaccaro O, Necton JD, Wentworth D, for the Multiple Risk Factor Intervention Trial Risk Group 1993 Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 16:434-444

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    In a previous study of diet-treated type 2 diabetic patients, blood glucose values before lunch were significantly lower than blood glucose measured 2 hours after breakfast.

    “In a study carried out on diet-treated type 2 diabetic patients, we showed that BG values before lunch were significantly lower than BG measured 2 h after breakfast (31).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] 31. Trovati M, Ponziani MC, Massucco P, Anfossi G, Mularoni EM, Burzacca S, - Tassone F, Perna P, Traversa M, Cavalot F 2002 Blood glucose pre-prandial baseline decreases from morning to evening in type 2 diabetes: role of fasting blood glucose and influence on post-prandial excursions. Eur J Clin Invest 32:179-186

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § First Published Online December 13, 2005

    In the Diabetes Intervention Study, post-breakfast glucose, unlike fasting glucose, predicted myocardial infarction and death in patients newly diagnosed with type 2 diabetes.

    “BG after breakfast, but not fasting BG, has been found to predict myocardial infarction and mortality in newly diagnosed type 2 diabetic patients (11).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] 11. Hanefeld M, Fischer S, Julius U, Schulze J, Schwanebeck U, Schmechel H, Ziegelasch HJ, Lindner J 1996 Risk factors for myocardial infarction and death in newly detected NIDDM: the Diabetes Intervention Study, 11-year follow-up. Diabetologia 39:1577-1583

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § First Published Online December 13, 2005

    Other studies find no significant sex differences in that risk.

    “whereas other studies do not show significant gender-related differences (6).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] 6. de Vegt F, Dekker JM, Ruhe HG, Stehouwer CD, Nijpels G, Bouter LM, HeineRJ 1999 Hyperglycaemia is associated with all-cause and cardiovascular mortality in the Hoorn population: the Hoorn study. Diabetologia 42:926-931

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation
    § Postprandial Blood Glucose Is a Stronger Predictor of Cardiovascular Events Than Fasting Blood Glucose in Type 2 Diabetes Mellitus, Particularly in Women: Lessons from the San Luigi Gonzaga Diabetes Study

    Blood glucose control has been linked to cardiovascular events in people with type 2 diabetes.

    “A relationship between BG control and cardiovascular events has also been observed in type 2 diabetic patients (10-12).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [10] 10. Laakso M 1999 Hyperglycemia and cardiovascular disease in type 2 diabetes. Diabetes 48:937-942

      Not checked in the free run.

    • cites [11] 11. Hanefeld M, Fischer S, Julius U, Schulze J, Schwanebeck U, Schmechel H, Ziegelasch HJ, Lindner J 1996 Risk factors for myocardial infarction and death in newly detected NIDDM: the Diabetes Intervention Study, 11-year follow-up. Diabetologia 39:1577-1583

      Not checked in the free run.

    • cites [12] 12. Standl E, Balletshofer B, Dahl B, Weichenhain B, Stiegler H, Hormann A, Holle R 1996 Predictors of 10-year macrovascular and overall mortality in patients with NIDDM: the Munich General Practitioner Project. Diabetologia 39:1540-1545

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data
    § First Published Online December 13, 2005

    In type 2 diabetes, postprandial glucose, not fasting glucose, independently predicts cardiovascular events.

    “Postprandial, but not fasting, blood glucose is an independent risk factor for cardiovascular events in type 2 diabetes”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The blood glucose profiles used at baseline reflect the patients' usual glycemic control.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    In the Diabetes Intervention Study, blood glucose after breakfast predicted cardiovascular events.

    “BG after breakfast predicted cardiovascular events in the DIS, but not in our study”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] 11. Hanefeld M, Fischer S, Julius U, Schulze J, Schwanebeck U, Schmechel H, Ziegelasch HJ, Lindner J 1996 Risk factors for myocardial infarction and death in newly detected NIDDM: the Diabetes Intervention Study, 11-year follow-up. Diabetologia 39:1577-1583

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Discussion

    In type 2 diabetes, the preprandial blood glucose baseline on which postmeal excursions are superimposed is not stable as in nondiabetic subjects but falls from morning to evening, probably because the early morning rise in counterregulatory hormones wanes.

    “As we described in a previous study, in type 2 diabetes the BG baseline on which postmeal excursions are superimposed (what we called the preprandial baseline) is not stable as it is in nondiabetic subjects, but decreases from morning to evening, probably because of waning of the early morning increase in counterregulatory hormones (31).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] 31. Trovati M, Ponziani MC, Massucco P, Anfossi G, Mularoni EM, Burzacca S, - Tassone F, Perna P, Traversa M, Cavalot F 2002 Blood glucose pre-prandial baseline decreases from morning to evening in type 2 diabetes: role of fasting blood glucose and influence on post-prandial excursions. Eur J Clin Invest 32:179-186

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation
    § First Published Online December 13, 2005

    Postchallenge and postprandial glucose measurements should be treated as separate.

    “postprandial and postload glucose concentrations should be kept clearly distinct (17).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] 17. Yudkin JS 2002 Post-load hyperglycaemia-an inappropriate therapeutic target. Lancet 359:166-167

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § Statistical analysis

    The proportional hazards assumption was tested with a log cumulative hazard plot.

    “Assumption of proportionality of hazards was tested using the log cumulative hazard plot, that is, the plot of log ( -log [S(t)]) vs. log of survival time, where S(t) represents the survival function.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation
    § Discussion

    Because postprandial excursions are superimposed on a falling preprandial blood glucose baseline, glycemic profiles in the present patients appear rather flat.

    “Thus, because postprandial excursions are superimposed to a falling preprandial BG baseline, glycemic profiles look rather flat in our patients (31).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] 31. Trovati M, Ponziani MC, Massucco P, Anfossi G, Mularoni EM, Burzacca S, - Tassone F, Perna P, Traversa M, Cavalot F 2002 Blood glucose pre-prandial baseline decreases from morning to evening in type 2 diabetes: role of fasting blood glucose and influence on post-prandial excursions. Eur J Clin Invest 32:179-186

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § First Published Online December 13, 2005

    In the general population, cardiovascular death rates are two to five times higher in men than women.

    “In the general population, cardiovascular mortality rate is two to five times greater in men than in women (19, 20).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [19] 19. Jackson R, Chambless L, Higgins M, Kuulasmaa K, Wijnberg L, Williams D 1997 WHO Monica Project, and ARIC Study sex difference in ischaemic heart disease mortality and risk factors in 46 communities: an ecologic analysis. Cardiovasc Risk Factors 7:43-54

      Not checked in the free run.

    • cites [20] 20. Jousilahti P, Vartiainen E, Tuomilehto J, Puska P 1999 Sex, age, cardiovascular risk factors, and coronary heart disease: a prospective follow-up study of 14786 middle-aged men and women in Finland. Circulation 99:1165-1172

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § Subjects and Methods

    Follow-up was completed for 484 of 529 patients (91.4%) by 2000.

    “in the year 2000, the follow-up was completed for 484 patients (91.4%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § Statistical analysis

    Residual analysis used log-cumulative hazard plots of Cox-Snell residuals to check linear prediction adequacy in the Cox models.

    “Residual analysis was conducted using log-cumulative hazard plots of Cox-Snell residuals to ascertain the adequacy of linear prediction in the Cox models.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data
    § Discussion

    Only a minority of the present patients measured blood glucose before lunch, so lunch-induced blood glucose excursions could not be evaluated in the whole cohort.

    “Thus, because only a minority of our patients measured BG before lunch, we could not evaluate the lunch-induced BG excursions in all of the cohort.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning
    § Discussion

    The discrepancy between the Diabetes Intervention Study and the present study regarding post-breakfast blood glucose is not surprising because breakfast in Germany and northwestern Italy differs strikingly in caloric and carbohydrate content.

    “this apparent discrepancy is not surprising because of the striking differences between the caloric and carbohydrate contents of breakfast in Germany and that in northwestern Italy.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: In Piedmont, breakfast is frequently a virtual meal consisting only of a cup of coffee and sometimes a small piece of bread.

  • Classified as probably not a substantial claim.

    Premisecitation
    § First Published Online December 13, 2005

    Some meta-analyses report hyperglycemia as a stronger cardiovascular risk factor in women than men.

    “Some meta-analyses state that hyperglycemia is a stronger cardiovascular risk factor in women than in men (22, 23)”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [22] 22. Orchard TJ 1996 The impact of gender and general risk factors on the occurrence of atherosclerotic vascular disease in non-insulin-dependent diabetes mellitus. Ann Med 28:323-333

      Not checked in the free run.

    • cites [23] 23. Lee WL, Cheung AM, Cape D, Zinman B 2000 Impact of diabetes on coronary artery disease in women and men: a meta-analysis of prospective studies. Diabetes Care 23:962-968

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § First Published Online December 13, 2005

    Other meta-analyses report that sex differences vanish after adjustment for major cardiovascular risk factors.

    “whereas other state that gender-related differences disappear after adjustment for the main cardiovascular risk factors (24).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] 24. Kanaya AM, Grady D, Barrett-Connor E 2002 Explaining the sex difference in coronary heart disease mortality among patients with type 2 diabetes mellitus: a meta-analysis. Arch Intern Med 162:1737-1745

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    Acarbose reduced the risk of myocardial infarction in type 2 diabetic patients.

    “Acarbose also reduced the risk of myocardial infarction in type 2 diabetic patients (35)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] 35. Hanefeld M, Cagatay M, Petrowitsch T, Neuser D, Petzinna D, Rupp M 2004 - Acarbose reduces the risk for myocardial infarction in type 2 diabetic patients: meta-analysis of seven long-term studies. Eur Heart J 25:10-16

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    Acarbose slowed the progression of intima media thickness of carotid arteries in subjects with impaired glucose tolerance.

    “and slowed the progression of intima media thickness of carotid arteries in subjects with impaired glucose tolerance (36).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] 36. Hanefeld M, Chiasson JL, Koehler C, Henkel E, Schaper F, TemelkovaKurktschiev T 2004 Acarbose slows progression of intima-media thickness of the carotid arteries in subjects with impaired glucose tolerance. Stroke 35: 1073-1078

      Not checked in the free run.

41 of 41

  • The paper relies on this without support.

    No prior study has examined whether sex affects the predictive value of postprandial glucose in patients with established type 2 diabetes.

    “As far as we know, no study addressed the influence of gender in the predictive power of postprandial (not postchallenge) BG in patients with an established diagnosis of type 2 diabetes.”

  • The paper relies on this without support.

    The blood glucose profiles used at baseline reflect the patients' usual glycemic control.

    “To get BG values truly reflecting the real glycemic control, we considered BG profiles available for clinical purposes at the routine visit in which the cardiovascular risk factors and HbA1c were measured”

  • The paper relies on this without support.

    Record linkage with hospital discharge and population registers accurately identifies cardiovascular events and deaths.

    “An individual record linkage with the hospital discharge database of the Piedmont region ( ∼ 4,200,000 inhabitants), the region in northwest Italy that includes Turin (the capital, with about 1,000,000 inhabitants), was conducted”
    “An individual record linkage using the individual fiscal code as the key linkage was conducted with the Turin historical population register”

  • The paper relies on this without support.

    The clinic-based cohort is representative of patients with type 2 diabetes generally.

    “In a population of 529 (284 men and 245 women) consecutive type 2 diabetic patients attending our diabetes clinic”

  • The paper relies on this without support.

    In Piedmont, breakfast is frequently a virtual meal consisting only of a cup of coffee and sometimes a small piece of bread.

    “Actually, breakfast in the Piedmont is frequently a virtual meal, consisting only of a cup of coffee with, sometimes, a small piece of bread.”

  • The paper relies on this without support.

    Hypoglycemic drugs are usually given in the morning.

    “because hypoglycemic drugs are usually given in the morning”

  • The paper relies on this without support.

    The differences between blood glucose after lunch and after breakfast underestimate the after-lunch glycemic increases.

    “(which underestimate the after lunch glycemic increases)”
7 of 7

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Postprandial dysmetabolism independently predicts future cardiovascular events even in people without diabetes.

    “Post-prandial dysmetabolism is an independent predictor of future cardiovascular events even in nondiabetic individuals.”

    From Dietary Strategies for Improving Post-Prandial Glucose, Lipids, Inflammation, and Cardiovascular Health (2008) · cites this paper as [8]

    The Discussion (page unavailable) reports that postprandial blood glucose independently predicts cardiovascular events, but the study measured this in patients with type 2 diabetes. The paper discusses cardiovascular risk in the general population, yet does not establish the claimed postprandial prediction in nondiabetic individuals. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • There are continuous linear direct relationships between post-challenge glucose levels and the risks of cardiovascular death and all-cause mortality.

    “Continuous linear direct relationships exist between glucose levels after a glucose challenge and the risks of both CV death and all-cause mortality (8).”

    From Dietary Strategies for Improving Post-Prandial Glucose, Lipids, Inflammation, and Cardiovascular Health (2008) · cites this paper as [8]

    The introduction (page unavailable) reports an association between higher blood glucose and cardiovascular disease, and the study reports that glucose after lunch predicted cardiovascular events. Our copy does not establish a continuous linear relationship between post-challenge glucose and either cardiovascular death or all-cause mortality; it also distinguishes post-challenge from postprandial glucose. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • The adverse effect of post-prandial or post-challenge hyperglycaemia appears stronger than that of fasting hyperglycaemia.

    “The adverse impact of post-prandial or post-challenge (OGTT) hyperglycaemia seems to be even stronger than that of fasting hyperglycaemia [5][6][7][8][9].”

    From Prevalence and correlates of post-prandial hyperglycaemia in a large sample of patients with type 2 diabetes mellitus (2006) · cites this paper as [7]

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. [29]29. Cochran WG and Cox GM 1950 Experimental designs. New York: Wiley &amp; Sons

Cited by

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Related

Authors
Cavalot, F., Petrelli, A., Traversa, M., Bonomo, K., Fiora, E., Conti, M., Anfossi, G., Costa, G., & Trovati, M.
Affiliations
  • Ospedale San Luigi Gonzaga (IT)
  • University of Turin (IT)
Corresponding author
Trovati, M.
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2006-03
Volume
91
Issue
3
Pages
813-819
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2005-1005
OpenAlex
W1967633321
Cited by
569
References
34
Citations by year
2026: 7 · 2025: 12 · 2024: 16 · 2023: 26 · 2022: 22 · 2021: 22 · 2020: 34 · 2019: 27 · 2018: 31 · 2017: 33 · 2016: 37 · 2015: 35 · 2014: 37 · 2013: 27 · 2012: 40
FWCI
21.15
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (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, fasting blood glucose, type 2 diabetes, cardiovascular events, cardiovascular risk prediction, sex differences, postprandial hyperglycemia, HbA1c
MeSH terms
Aged, Blood Glucose, Blood Pressure, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Fasting, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Sex Characteristics, Biomarkers, Body Mass Index, Postprandial Period

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-27.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-27.

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