Skip to main content
SpringerLink
Log in

Prandial glucose regulation in the glucose triad

Emerging evidence and insights

  • Clinical Update
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

While it is well established that overall glycemic control reduces the complications of diabetes, the role of fasting glycemia versus postprandial glycemia in the pathophysiology of diabetes and its complications, and the relative importance of these parameters as specific targets of therapy, remain controversial. Evidence that postprandial glucose (PPG) plays an independent, modifiable role in cardiovascular disease is accumulating, largely from epidemiological studies. A large number of epidemiological studies show that high postprandial glucose is an independent risk factor for cardiovascular disease: indeed, a more powerful risk factor than fasting glucose or HbA1c. Pathophysiological hypotheses that support these observations include the contribution of postprandial glucose to HbA1c; postprandial glucose as a surrogate marker for other cardiovascular risk factors, serum lipids and triglycerides in particular; and direct toxicity of elevated glucose levels attributed to "spikes" in glucose concentration following caloric ingestion. Early interventional data suggest that therapy targeted at postprandial glucose can have a favorable impact on cardiovascular events. While more interventional studies clearly are needed, the growing weight of evidence supports a therapeutic approach more directed at excessive prandial glycemic excursions that are characteristic of both type 1 and type 2 diabetes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Harris, M., Flegal, K. M., Cowie, C. C., et al. (1998). Diabetes Care 21, 518–524.

    Article  PubMed  CAS  Google Scholar 

  2. The DECODE Study Group (2003). Diabetes Care 26, 61–69.

    Article  Google Scholar 

  3. The DECODE Study Group (2003). Diabetes Care 26, 688–696.

    Article  Google Scholar 

  4. DCCT Research Group (1993). N. Engl. J. Med. 329(14), 977–986.

    Article  Google Scholar 

  5. UK Prospective Diabetes Study (UKPDS) Group (1998). Lancet 352(9131), 837–853.

    Article  Google Scholar 

  6. DECODE Study Group (1999). Lancet 354, 617–621.

    Article  Google Scholar 

  7. Tominaga, M., Eguchi, H., Manaka, H., Igarashi, K., Kato, T., and Sekikawa, A. (1999). Diabetes Care 22(6), 920–924.

    Article  PubMed  CAS  Google Scholar 

  8. Balkau, B., Shipley, M., Jarrett, R. J., et al. (1998). Diabetes Care 21, 360–373.

    Article  PubMed  CAS  Google Scholar 

  9. Barrett-Connor, E. and Ferrara, A. (1998). Diabetes Care 21, 1236–1239.

    Article  PubMed  CAS  Google Scholar 

  10. Hanefeld, M., Fischer, S., Julius, U., et al. (1996). Diabetologia 39, 1577–1583.

    Article  PubMed  CAS  Google Scholar 

  11. Chiasson, J. L., Josse, R. G., Gomis, R., Hanefeld, M., Karasik, A., and Laakso, M.; STOP-NIDDM Trial Research Group (2003). JAMA 290, 486–494.

    Article  PubMed  CAS  Google Scholar 

  12. Monnier, L., Lapinski, H., and Colette, C. (2003). Diabetes Care 26, 881–885.

    Article  PubMed  Google Scholar 

  13. Esposito, K., Giugliano, D., Nappo, F., and Marfella, R. (2004). Circulation 110, 214–219.

    Article  PubMed  CAS  Google Scholar 

  14. Stamler, J., Vaccaro, O., Neaton, J. D., and Wentworth, D. (1993). Diabetes Care 16, 434–444.

    Article  PubMed  CAS  Google Scholar 

  15. The DECODE Study Group (2003). Diabetologia 46, 608–617.

    Article  Google Scholar 

  16. Haffner, S. M., Lehto, S., Ronnemaa, T., Pyorala, K., and Laakso, M. (1998). N. Engl. J. Med. 339, 229–234.

    Article  PubMed  CAS  Google Scholar 

  17. Coutinho, M., Gerstein, H. C., Wang, Y., and Yusuf, S. (1999). Diabetes Care 22, 233–240.

    Article  PubMed  CAS  Google Scholar 

  18. Temelkova-Kurktschiev, T., Koehler, C., Henkel, E., Leonhardt, W., Fuecker, K., and Hanefeld, M. (2000). Diabetes Care 23, 1830–1834.

    Article  PubMed  CAS  Google Scholar 

  19. de Veciana, M., Major, C. A., Morgan, M. A., et al. (1995). N. Engl. J. Med. 333, 1237–1241.

    Article  PubMed  Google Scholar 

  20. Manderson, J. G., Patterson, C. C., Hadden, D. R., Traub, A. I., Ennis, C., and McCance, D. R. (2003). Am. J. Obstet. Gynecol. 189, 507–512.

    Article  PubMed  Google Scholar 

  21. Stratton, I. M., Adler, A. I., Neil, H. A. W., et al. (2000). Br. Med. J. 321(7258), 405–412.

    Article  CAS  Google Scholar 

  22. Kuusisto, J., Mykkanen, L., Pyorala, K., and Laakso, M. (1994). Diabetes 43(8), 960–967.

    Article  PubMed  CAS  Google Scholar 

  23. DCCT Research Group (1995). Diabetes 44, 968–983.

    Article  Google Scholar 

  24. Shichiri, M., Kishikawa, H., Ohkubo, Y., and Wake, N. (2000). Diabetes Care 23(Suppl. 2), B21-B29.

    PubMed  Google Scholar 

  25. Avignon, A., Radauceanu, A., and Monnier, L. (1997). Diabetes Care 20, 1822–1826.

    Article  PubMed  CAS  Google Scholar 

  26. Bos, G., Dekker, J. M., Nijpels, G., et al. (2003). Diabetologia Jul. 46(7), 910–916 (Epub Jun. 18).

    Article  CAS  Google Scholar 

  27. Bos, G., Dekker, J. M., and Heine, R. J. (2004). Diabetes Care 27, 283–284.

    Article  PubMed  Google Scholar 

  28. Heine, R. J. and Dekker, J. M. (2002). Diabetologia 45, 461–475.

    Article  PubMed  CAS  Google Scholar 

  29. Vogel, R. A., Corretti, M. C., and Plotnick, G. D. (1997). Am. J. Cardiol. 79, 350–354.

    Article  PubMed  CAS  Google Scholar 

  30. Ceriello, A., Taboga, C., Tonutti, L., et al. (2002). Circulation 106, 1211–1218.

    Article  PubMed  Google Scholar 

  31. de Vegt, F., Dekker, J. M., Ruhe, H. G., et al. (1999). Diabetologia 42, 926–931.

    Article  PubMed  Google Scholar 

  32. Muggeo, M., Zoppini, G., Bonora, E., et al. (2000). Diabetes Care 23(1), 45–50.

    Article  PubMed  CAS  Google Scholar 

  33. Beisswenger, P. J., Makita, Z., Curphey, T. J., et al. (1995). Diabetes 44(7), 824–829.

    Article  PubMed  CAS  Google Scholar 

  34. Beisswenger, P. J., Szwergold, B. S., and Yeo, K. T. (2001). Clin. Lab. Med. 21(1), 53–78.

    PubMed  CAS  Google Scholar 

  35. Szwergold, B. S., Howell, S., and Beisswenger, P. J. (2001). Diabetes 50(9), 2139–2147.

    Article  PubMed  CAS  Google Scholar 

  36. McLellan, A. C., Thornalley, P. J., Benn, J., and Sonksen, P. H. (1994). Clin. Sci. 87, 21–29.

    PubMed  CAS  Google Scholar 

  37. Beisswenger, P. J., Howell, S. K., O’Dell, R. M., Wood, M. E., Touchette, A. D., and Szwergold, B. S. (2001). Diabetes Care 24, 726–732.

    Article  PubMed  CAS  Google Scholar 

  38. Brownlee, M. (2001). Nature 414, 813–820.

    Article  PubMed  CAS  Google Scholar 

  39. Dandona, P., Mohanty, P., Ghanim, H., et al. (2001). J. Clin. Endocrinol. Metab. 86(1), 355–362.

    Article  PubMed  CAS  Google Scholar 

  40. Ceriello, A., Bortolotti, N., Motz, E., et al. (1999). Metabolism 48(12), 1503–1508.

    Article  PubMed  CAS  Google Scholar 

  41. American Diabetes Association Clinical Practice Recommendations (2003). Diabetes Care 26(Suppl. 1), S1-S1081.

    Google Scholar 

  42. DECODE Study Group (1998). Br. Med. J. 317, 371–375.

    Google Scholar 

  43. The DECODA Study Group on behalf of the International Diabetes Epidemiology Group (2000). Diabetologia 43, 1470–1475.

    Article  Google Scholar 

  44. Holst, J. J. and Deacon, C. F. (2004). Curr. Opin. Pharmacol. 4, 589–596.

    Article  PubMed  CAS  Google Scholar 

  45. Culy, C. R. and Jarvis, B. (2001). Drugs 61, 1625–1660.

    Article  PubMed  CAS  Google Scholar 

  46. Tuomilehto, J., Lindström, J., Eriksson, J., et al. (2001). N. Engl. J. Med. 346(6), 393–403.

    Google Scholar 

  47. Diabetes Prevention Program Research Group (2002). N. Engl. J. Med. 344, 1342–1350

    Google Scholar 

  48. Shaw, J. E., Hodge, A. M., de Courten, M., Chitson, P., and Zimmet, P. Z. (1999). Diabetologia 42, 1050–1054.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH

    Paul Beisswenger

  2. University Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Robert J. Heine

  3. University of Toronto, St Michael’s Hospital, University of Toronto, Toronto, Canada

    Lawrence A. Leiter

  4. Joslin Diabetes Center, Harvard Medical School, Boston, MA

    Alan Moses

  5. Academy of Finland, University of Helsinki, National Public Health Institute, Helsinki, Finland

    Jaakko Tuomilehto

Authors
  1. Paul Beisswenger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert J. Heine
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lawrence A. Leiter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alan Moses
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jaakko Tuomilehto
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Beisswenger, P., Heine, R.J., Leiter, L.A. et al. Prandial glucose regulation in the glucose triad. Endocr 25, 195–202 (2004). https://doi.org/10.1385/ENDO:25:3:195

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1385/ENDO:25:3:195

Key Words

Search

Navigation