Postprandial Hyperglycemia and Glycemic Variability
Open accessAbstract
The aim of this article is to evaluate the pros and cons of a specific impact of postprandial hyperglycemia and glycemic variability on the—mainly cardiovascular (CV)—complications of diabetes, above and beyond the average blood glucose (BG) as measured by HbA1c or fasting plasma glucose (FPG). The strongest arguments in favor of this hypothesis come from impressive pathophysiological studies, also in the human situation. Measures of oxidative stress and endothelial dysfunction seem to be especially closely related to glucose peaks and even more so to fluctuating high and low glucose concentrations and can be restored to normal by preventing those glucose peaks or wide glucose excursions. The epidemiological evidence, which is more or less confined to postprandial hyperglycemia and postglucose load glycemia, is also rather compelling in favor of the hypothesis, although certainly not fully conclusive as there are also a number of conflicting results. The strongest cons are seen in the missing evidence as derived from randomized prospective intervention studies targeting postprandial hyperglycemia longer term, i.e., over several years, and seeking to reduce hard CV end points. In fact, several such intervention studies in men have recently failed to produce the intended beneficial outcome results. As this evidence by intervention is, however, key for the ultimate approval of a treatment concept in patients with diabetes, the current net balance of attained evidence is not in favor of the hypothesis here under debate, i.e., that we should care about postprandial hyperglycemia and glycemic variability. The absence of a uniformly accepted standard of how to estimate these parameters adds a further challenge to this whole debate.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
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?
In the majority of relatively well-controlled patients with type 2 diabetes, postprandial glycemic excursions predominate over fasting blood glucose in contributing to HbA1c.
“In the majority of patients with type 2 diabetes, who are relatively wellcontrolled, postprandial glycaemic excursions predominate over fasting blood glucose levels in contributing to HbA1c (62)”
From Gut mechanisms linking intestinal sweet sensing to glycemic control (2018) · cites this paper as [62]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Monnier, L., Mas, E., Ginet, C., Michel, F., Villon, L., Cristol, J.-P., & Colette, C. (2006) · JAMA · doi:10.1001/jama.295.14.1681 · Cited by 2,444 · see citing works
Esposito, K., Nappo, F., Marfella, R., Giugliano, G., Giugliano, F., Ciotola, M., Quagliaro, L., Ceriello, A., & Giugliano, D. (2002) · Circulation · doi:10.1161/01.cir.0000034509.14906.ae · Cited by 1,961 · see citing works
Self-citationCoutinho, M., Gerstein, H. C., Wang, Y., & Yusuf, S. (1999) · Diabetes Care · doi:10.2337/diacare.22.2.233 · Cited by 1,685 · see citing works
Chiasson, J.-L., Josse, R. G., Gomis, R., Hanefeld, M., Karasik, A., Laakso, M., & for The STOP-NIDDM Trial Research Group (2003) · JAMA · doi:10.1001/jama.290.4.486 · Cited by 1,624 · see citing works
Home, P. D., Pocock, S. J., Beck-Nielsen, H., Curtis, P. S., Gomis, R., Hanefeld, M., Jones, N. P., Komajda, M., & McMurray, J. J. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60953-3 · Cited by 1,393 · see citing works
Ray, K. K., Seshasai, S. R. K., Wijesuriya, S., Sivakumaran, R., Nethercott, S., Preiss, D., Erqou, S., & Sattar, N. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60697-8 · Cited by 1,383 · see citing works
(1999) · The Lancet · doi:10.1016/s0140-6736(98)12131-1 · Cited by 1,313 · see citing works
Borch‐Johnsen, K., Neil, A., Balkau, B., Larsen, S. H., Nissinen, A. E. T., Pekkanen, J., Keinanen-Kiukaanniemi, S. M., Hiltunen, L. A., Kivelä, S., Tuomilehto, J. O., et al. (1999) · The Lancet · Cited by 1,272 · see citing works
Intensive glucose control and macrovascular outcomes in type 2 diabetes
Turnbull, F. M., Abraira, C., Anderson, R. J., Byington, R. P., Chalmers, J. P., Duckworth, W. C., Evans, G. W., Gerstein, H. C., Holman, R. R., Moritz, T. E., et al. (2009) · Diabetologia · doi:10.1007/s00125-009-1470-0 · Cited by 1,189 · see citing works
Tominaga, M., Eguchi, H., Manaka, H., Igarashi, K., Kato, T., & Sekikawa, A. (1999) · Diabetes Care · doi:10.2337/diacare.22.6.920 · Cited by 1,165 · see citing works
Mean Amplitude of Glycemic Excursions, a Measure of Diabetic Instability
Service, F. J., Molnar, G. D., Rosevear, J. W., Ackerman, E., Gatewood, L. C., & Taylor, W. F. (1970) · Diabetes · doi:10.2337/diab.19.9.644 · Cited by 1,039 · see citing works
Hanefeld, M., Fischer, S., Julius, U., Schulze, J., Schwanebeck, U., Schmechel, H., Ziegelasch, H. J., & Lindner, J. (1996) · Diabetologia · doi:10.1007/s001250050617 · Cited by 873 · see citing works
Variability of Blood Glucose Concentration and Short-term Mortality in Critically Ill Patients
Egi, M., Bellomo, R., Stachowski, E., French, C., & Hart, G. K. (2006) · Anesthesiology · doi:10.1097/00000542-200608000-00006 · Cited by 847 · see citing works
Quagliaro, L., Piconi, L., Assaloni, R., Martinelli, L., Motz, E., & Ceriello, A. (2003) · Diabetes · doi:10.2337/diabetes.52.11.2795 · Cited by 771 · see citing works
Self-citationGlycemic variability: A strong independent predictor of mortality in critically ill patients.
Krinsley, J. S. (2008) · Critical Care Medicine · doi:10.1097/ccm.0b013e31818b38d2 · Cited by 729 · see citing works
Barr, E. L. M., Zimmet, P. Z., Welborn, T. A., Jolley, D., Magliano, D. J., Dunstan, D. W., Cameron, A. J., Dwyer, T., Taylor, H. R., Tonkin, A. M., et al. (2007) · Circulation · doi:10.1161/circulationaha.106.685628 · Cited by 719 · see citing works
Kawano, H., Motoyama, T., Hirashima, O., Hirai, N., Miyao, Y., Sakamoto, T., Kugiyama, K., Ogawa, H., & Yasue, H. (1999) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(99)00168-0 · Cited by 676 · see citing works
de Vegt, F., Dekker, J. M., Ruhé, H. G., Stehouwer, C. D. A., Nijpels, G., Bouter, L. M., & Heine, R. J. (1999) · Diabetologia · doi:10.1007/s001250051249 · Cited by 611 · see citing works
Balkau, B., Shipley, M. J., Jarrett, R. J., Pyörälà, K., Pyörälä, M., Forhan, A., & Eschwège, É. (1998) · Diabetes Care · doi:10.2337/diacare.21.3.360 · Cited by 597 · see citing works
Cavalot, F., Petrelli, A., Traversa, M., Bonomo, K., Fiora, E., Conti, M., Anfossi, G., Costa, G., & Trovati, M. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-1005 · Cited by 569 · see citing works
Fasting and Postchallenge Glycemia and Cardiovascular Disease Risk
Meigs, J. B., Nathan, D. M., D’Agostino, R. B., & Wilson, P. W. F. (2002) · Diabetes Care · doi:10.2337/diacare.25.10.1845 · Cited by 509 · see citing works
Effect of nateglinide on the incidence of diabetes and cardiovascular events
(2010) · New England Journal of Medicine · doi:10.1056/nejmoa1001122 · Cited by 477 · see citing works
Should minimal blood glucose variability become the gold standard of glycemic control?
Hirsch, I. B., & Brownlee, M. (2005) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2004.10.001 · Cited by 405 · see citing works
The Effect of Glucose Variability on the Risk of Microvascular Complications in Type 1 Diabetes
Kilpatrick, E. S., Rigby, A. S., & Atkin, S. L. (2006) · Diabetes Care · doi:10.2337/dc06-0293 · Cited by 376 · see citing works
Barrett-Connor, E., & Ferrara, A. (1998) · Diabetes Care · doi:10.2337/diacare.21.8.1236 · Cited by 369 · see citing works
A Novel Approach to Continuous Glucose Analysis Utilizing Glycemic Variation
McDonnell, C. M., Donath, S. M., Vidmar, S., Werther, G. A., & Cameron, F. J. (2005) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2005.7.253 · Cited by 358 · see citing works
Raz, I., Wilson, P. W. F., Strojek, K., Kowalska, I., Bozikov, V., Gitt, A. K., Jermendy, G., Campaigne, B. N., Kerr, L., Milicevic, Z., et al. (2009) · Diabetes Care · doi:10.2337/dc08-1671 · Cited by 351 · see citing works
Evaluation of a New Measure of Blood Glucose Variability in Diabetes
Kovatchev, B. P., Otto, E., Cox, D. J., Gonder-Frederick, L. A., & Clarke, W. L. (2006) · Diabetes Care · doi:10.2337/dc06-1085 · Cited by 333 · see citing works
the DECODA Study Group, & Nakagami, T. (2004) · Diabetologia · doi:10.1007/s00125-004-1334-6 · Cited by 331 · see citing works
Piconi, L., Quagliaro, L., Assaloni, R., ROS, R. D., Maier, A., Zuodar, G., & Ceriello, A. (2006) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.613 · Cited by 326 · see citing works
Self-citationQUAGLIARO, L., PICONI, L., ASSALONI, R., DAROS, R., MAIER, A., ZUODAR, G., & CERIELLO, A. (2005) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2005.03.015 · Cited by 268 · see citing works
Self-citationIsolated post-challenge hyperglycaemia confirmed as a risk factor for mortality
Shaw, J. E., Hodge, A. M., de Courten, M., Chitson, P., & Zimmet, P. (1999) · Diabetologia · doi:10.1007/s001250051269 · Cited by 255 · see citing works
Lowe, L. P., Liu, K., Greenland, P., Metzger, B. E., Dyer, A. R., & Stamler, J. (1997) · Diabetes Care · doi:10.2337/diacare.20.2.163 · Cited by 235 · see citing works
Postchallenge Hyperglycemia and Mortality in a National Sample of U.S. Adults
Saydah, S. H., Miret, M., Sung, J., Varas, C., Gause, D., & Brancati, F. L. (2001) · Diabetes Care · doi:10.2337/diacare.24.8.1397 · Cited by 221 · see citing works
Glycemic Control Is a Predictor of Survival for Diabetic Patients on Hemodialysis
Morioka, T., Emoto, M., Tabata, T., Shoji, T., Tahara, H., Kishimoto, H., Ishimura, E., & Nishizawà, Y. (2001) · Diabetes Care · doi:10.2337/diacare.24.5.909 · Cited by 221 · see citing works
Defective intracellular antioxidant enzyme production in type 1 diabetic patients with nephropathy.
Ceriello, A., Morocutti, A., Mercuri, F., Quagliaro, L., Moro, M., Damante, G., & Viberti, G. C. (2000) · Diabetes · doi:10.2337/diabetes.49.12.2170 · Cited by 209 · see citing works
Self-citationGlucose fluctuations and activation of oxidative stress in patients with type 1 diabetes
Wentholt, I. M. E., Kulik, W., Michels, R. P. J., Hoekstra, J. B. L., & DeVries, J. H. (2007) · Diabetologia · doi:10.1007/s00125-007-0842-6 · Cited by 201 · see citing works
Qiao, Q. (2002) · European Heart Journal · doi:10.1053/euhj.2001.3113 · Cited by 180 · see citing works
Rodríguez, B. L., Lau, N., Burchfiel, C. M., Abbott, R. D., Sharp, D. S., Yano, K., & Curb, J. D. (1999) · Diabetes Care · doi:10.2337/diacare.22.8.1262 · Cited by 171 · see citing works
Barr, E., Boyko, E. J., Zimmet, P., Wolfe, R. S., Tonkin, A. M., & Shaw, J. E. (2009) · Diabetologia · doi:10.1007/s00125-008-1246-y · Cited by 166 · see citing works
Relation between blood glucose and coronary mortality over 33 years in the Whitehall Study
Brunner, E. J., Shipley, M. J., Witte, D. R., Fuller, J. H., & Marmot, M. G. (2006) · Diabetes Care · doi:10.2337/diacare.29.01.06.dc05-1405 · Cited by 166 · see citing works
Azuma, K., Kawamori, R., Toyofuku, Y., Kitahara, Y., Sato, F., Shimizu, T., Miura, K., Mine, T., Tanaka, Y., Mitsumata, M., et al. (2006) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.0000239488.05069.03 · Cited by 160 · see citing works
“J”-Index. A New Proposition of the Assessment of Current Glucose Control in Diabetic Patients
Wojcicki, J. (1995) · Hormone and Metabolic Research · doi:10.1055/s-2007-979906 · Cited by 156 · see citing works
Postprandial Myocardial Perfusion in Healthy Subjects and in Type 2 Diabetic Patients
Scognamiglio, R., Negut, C., De Kreutzenberg, S. V., Tiengo, A., & Avogaro, A. (2005) · Circulation · doi:10.1161/circulationaha.104.495127 · Cited by 153 · see citing works
Smith, N. L., Barzilay, J. I., Shaffer, D., Savage, P. J., Heckbert, S. R., Kuller, L. H., Kronmal, R. A., Resnick, H. E., & Psaty, B. M. (2002) · Archives of Internal Medicine · doi:10.1001/archinte.162.2.209 · Cited by 150 · see citing works
Glutathione reverses systemic hemodynamic changes induced by acute hyperglycemia in healthy subjects
Marfella, R., Verrazzo, G., Acampora, R., La Marca, C., Giunta, R., Lucarelli, C., Paolisso, G., Ceriello, A., & Giugliano, D. (1995) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.1995.268.6.e1167 · Cited by 129 · see citing works
Self-citationService, F. J., & O'Brien, P. C. (2001) · Diabetologia · doi:10.1007/s001250100635 · Cited by 106 · see citing works
The post‐prandial state in Type 2 diabetes and endothelial dysfunction: effects of insulin aspart
Ceriello, A., Cavarape, A., Martinelli, L., ROS, R. D., Marra, G., Quagliaro, L., Piconi, L., Assaloni, R., & Motz, E. (2004) · Diabetic Medicine · doi:10.1111/j.1464-5491.2004.01101.x · Cited by 103 · see citing works
Self-citationA new look at the heart in diabetes mellitus: from ailing to failing
Standl, E., & Schnell, O. (2000) · Diabetologia · doi:10.1007/s001250051556 · Cited by 100 · see citing works
Self-citationWascher, T. C., Schmoelzer, I., Wiegratz, A., Stuehlinger, M., Müller‐Wieland, D., Kotzka, J., & Enderle, M. (2005) · European Journal of Clinical Investigation · doi:10.1111/j.1365-2362.2005.01550.x · Cited by 80 · see citing works
Meugnier, E., Faraj, M., Rome, S., Beauregard, G., Michaut, A., Pelloux, V., Chiasson, J.-L., Laville, M., Clement, K., Vidal, H., et al. (2007) · Diabetes · doi:10.2337/db06-1242 · Cited by 76 · see citing works
The Assessment of Glycemic Variability and Its Impact on Diabetes-Related Complications: An Overview
Weber, C., & Schnell, O. (2009) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2009.0043 · Cited by 72 · see citing works
Self-citationScognamiglio, R., Negut, C., de Kreutzenberg, S. V., Tiengo, A., & Avogaro, A. (2006) · Diabetes Care · doi:10.2337/diacare.29.01.06.dc05-0955 · Cited by 72 · see citing works
Swings in blood glucose levels accelerate atherogenesis in apolipoprotein E-deficient mice
Mita, T., Otsuka, A., Azuma, K., Uchida, T., Ogihara, T., Fujitani, Y., Hirose, T., Mitsumata, M., Kawamori, R., & Watada, H. (2007) · Biochemical and Biophysical Research Communications · doi:10.1016/j.bbrc.2007.04.118 · Cited by 67 · see citing works
Vaccaro, O., Ruth, K. J., & Stamler, J. (1992) · Diabetes Care · doi:10.2337/diacare.15.10.1328 · Cited by 60 · see citing works
Orencia, A. J., Daviglus, M. L., Dyer, A. R., Walsh, M. K., Greenland, P., & Stamler, J. (1997) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(97)00201-1 · Cited by 57 · see citing works
Nonfasting Serum Glucose and the Risk of Fatal Stroke in Diabetic and Nondiabetic Subjects
Håheim, L. L., Holme, I., Hjermann, I., & Leren, P. (1995) · Stroke · doi:10.1161/01.str.26.5.774 · Cited by 51 · see citing works
Azuma, K., Toyofuku, Y., Iesaki, T., Otsuka, A., Tanaka, A., Mita, T., Hirose, T., Tanaka, Y., Daida, H., Kawamori, R., et al. (2006) · Biochemical and Biophysical Research Communications · doi:10.1016/j.bbrc.2006.04.090 · Cited by 43 · see citing works
A new En face method is useful to quantitate endothelial damage in vivo
Azuma, K., Watada, H., Niihashi, M., Otsuka, A., Sato, F., Kawasumi, M., Shimada, S., Tanaka, Y., Kawamori, R., & Mitsumata, M. (2003) · Biochemical and Biophysical Research Communications · doi:10.1016/j.bbrc.2003.08.013 · Cited by 31 · see citing works
Ihnat, M. A., Kaltreider, R. C., Thorpe, J. E., Green, D. E., Kamat, C. D., Leeper, M., Shanner, A. C., Warnke, L. A., Piconi, L., & Ceriello, A. (2007) · American journal of biochemistry & biotechnology/American journal of biochemistry and biotechnology · doi:10.3844/ajbbsp.2007.16.23 · Cited by 21 · see citing works
Self-citationLong-term Risk of Cardiovascular Events With Rosiglitazone: A Meta-analysis
Singh, S., Loke, Y. K., & Furberg, C. D. (2007) · JAMA · doi:10.1001/jama.298.10.1189 · Cited by 5 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Glycemic Variability: How Do We Measure It and Why Is It Important?
Suh, S., & Kim, J. H. (2015) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2015.39.4.273 · Cited by 439 · see citing works
Relationships Between Gastric Emptying, Postprandial Glycemia, and Incretin Hormones
Marathe, C. S., Rayner, C. K., Jones, K. L., & Horowitz, M. (2013) · Diabetes Care · doi:10.2337/dc12-1609 · Cited by 335 · see citing works
Shahim, B., De Bacquer, D., De Backer, G., Gyberg, V., Kotseva, K., Mellbin, L., Schnell, O., Tuomilehto, J., Wood, D., & Rydén, L. (2017) · Diabetes Care · doi:10.2337/dc17-0245 · Cited by 114 · see citing works
Self-citationMatsutani, D., Sakamoto, M., Iuchi, H., Minato, S., Suzuki, H., Kayama, Y., Takeda, N., Horiuchi, R., & Utsunomiya, K. (2018) · Cardiovascular Diabetology · doi:10.1186/s12933-018-0683-2 · Cited by 52 · see citing works
Gut mechanisms linking intestinal sweet sensing to glycemic control
Kreuch, D., Keating, D. J., Wu, T., Horowitz, M., Rayner, C. K., & Young, R. L. (2018) · Frontiers in Endocrinology · doi:10.3389/fendo.2018.00741 · Cited by 40 · see citing works
Pai, Y.-W., Tang, C.-L., Lin, C.-H., Lin, S.-Y., Lee, I.-T., & Chang, M.-H. (2021) · Diabetes & Metabolism · doi:10.1016/j.diabet.2020.04.004 · Cited by 20 · see citing works
Kasthuri, S., Poongothai, S., Anjana, R. M., Selvakumar, J., Muthukumar, S., Kayalvizhi, S., Tariq, S., Honey, E., Gupta, P. K., Venkatesan, U., et al. (2021) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2019.0484 · Cited by 13 · see citing works
Manski‐Nankervis, J., Yates, C. J., Blackberry, I., Furler, J., Ginnivan, L., Cohen, N., Jenkins, A., Vasanthakumar, S., Gorelik, A., Young, D., et al. (2016) · Diabetic Medicine · doi:10.1111/dme.12979 · Cited by 8 · see citing works
- Authors
- Standl, E., Schnell, O., & Ceriello, A.
- Affiliations
- Helmholtz Munich (DE)
- MultiMedica (IT)
- Corresponding author
- Standl, Eberhard
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2011-04-22
- Volume
- 34
- Issue
- Supplement_2
- Pages
- S120-S127
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC3632148
- OpenAlex
- W2027398852
- Cited by
- 183
- References
- 62
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 5 · 2023: 6 · 2022: 5 · 2021: 5 · 2020: 12 · 2019: 9 · 2018: 22 · 2017: 16 · 2016: 15 · 2015: 22 · 2014: 14 · 2013: 16 · 2012: 12
- FWCI
- 12.60
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- postprandial hyperglycemia, glycemic variability, cardiovascular complications of diabetes, oxidative stress, endothelial dysfunction, glycemic excursions, HbA1c, fasting blood glucose, postprandial blood glucose, cardiovascular risk
- MeSH terms
- Blood Glucose, Cardiovascular Diseases, Fasting, Glycated Hemoglobin, Humans, Hyperglycemia
About these checks
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.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
