Morning Hyperglycemic Excursions
Open accessAbstract
OBJECTIVE—To determine whether, over daytime, one or several hyperglycemic excursions exist that can be general failures in the glycemic control of patients with type 2 diabetes. RESEARCH DESIGN AND METHODS—In 200 non–insulin-using patients with type 2 diabetes, diurnal plasma glucose and insulin profiles were studied. Plasma glucose concentrations were measured after an overnight fast (at 8:00 a.m. immediately before breakfast), during the postprandial period (at 11:00 a.m. and 2:00 p.m.), and during the postabsorptive period (at 5:00 p.m., extended postlunch time). RESULTS—In the population considered as a whole, prelunch glucose concentrations (12.0 mmol/l) were found to be significantly increased (P < 0.0001) when compared with those observed at 8:00 a.m. (8.8 mmol/l), at 2:00 p.m. (10.5 mmol/l), and at 5:00 p.m. (8.6 mmol/l). Similar significant excursions (P < 0.0001) in prelunch glucose were observed within subsets of patients selected from the following criteria: 1) body weight, 2) HbA1c, 3) categories of treatment, and 4) residual β-cell function. From the calculation of areas under the daytime glucose curves, the relative contributions of postprandial and fasting glucose to the total glucose increment were found to be similar. CONCLUSIONS—High plasma glucose excursions over morning periods seem to be a permanent failure in non–insulin-using patients with type 2 diabetes, whatever the clinical (BMI), biological (HbA1c), therapeutic, and pathophysiological (residual β-cell function) status. Midmorning glucose testing should be recommended for detecting such abnormalities and for correcting them with appropriate therapies.
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Only two small series of type 2 diabetes subjects have collected data on circadian glucose levels, and their results were partially conflicting.
“only in two small series of subjects with type 2 diabetes have data on circadian glucose levels been collected, and the results were partially conflicting [13][14][15][16].”
From Prevalence and correlates of post-prandial hyperglycaemia in a large sample of patients with type 2 diabetes mellitus (2006) · cites this paper as [15]
The study was unable to confirm the finding by Monnier and coworkers that prelunch glucose concentration was higher than pre-breakfast and post-lunch glucose levels.
“We were not able to confirm this finding.”
From Prevalence and correlates of post-prandial hyperglycaemia in a large sample of patients with type 2 diabetes mellitus (2006) · cites this paper as [15]
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- Authors
- Monnier, L., Colette, C., Rabasa-Lhoret, R., Lapinski, H., Caubel, C., Avignon, A., & Boniface, H.
- Affiliations
- Hôpital Lapeyronie (FR)
- University Institute of Clinical Research, Montpellier, France
- Department of Metabolic Diseases, Lapeyronie Hospital, Montpellier, France
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2002-04-01
- Volume
- 25
- Issue
- 4
- Pages
- 737-741
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2161743236
- Cited by
- 96
- References
- 24
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 2 · 2021: 1 · 2020: 3 · 2019: 5 · 2018: 4 · 2017: 2 · 2016: 4 · 2015: 2 · 2014: 9 · 2013: 4 · 2012: 1
- FWCI
- 2.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, glycemic control, postprandial blood glucose, fasting blood glucose, residual beta-cell function, HbA1c, body mass index
- MeSH terms
- Adult, Blood Glucose, Circadian Rhythm, Diabetes Mellitus, Type 2, Female, Humans, Hyperglycemia, Insulin, Male, Middle Aged, Body Mass Index, Treatment Failure, Postprandial Period
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