DOC News September 1, 2007
Volume 4 Number 9 p. 15
© 2007 American Diabetes Association
PPG Proves Key to Glycemic Control
Which is the more important benchmark on which to base glycemic therapy:
levels of fasting plasma glucose (FPG) or levels of postprandial plasma
glucose (PPG)?
To find out, investigators in Munich, Germany, conducted a study with 164
people with poorly controlled diabetes. All of the participants had glycated
hemoglobin (A1C) levels above 7.5%. Providers used FPG as the therapy guide in
half the participants and PPG as the guide in the other half. Providers
administered oral sulfonylurea to patients unable to control glycemia with
diet alone. If sulfonylurea was insufficient, they initiated metformin
therapy, and if still further control was necessary, they added insulin to the
regimen.
At the end of 3 months, the researchers rechecked patients' A1C levels.
They found that patients' glucose control was better when PPG was used to
guide therapy. Only 64% of people using FPG reached the study's A1C target of
7%, while 94% of people using PPG reached the 7% target.
Overall, reducing PPG accounted for twice as much improvement in A1C as
reducing FPG did, according to the
researchers.
"Control of fasting hyperglycemia is necessary but usually
insufficient for achieving" A1C goals, the researchers conclude.
"Control of postprandial hyperglycemia is essential for achieving
recommended [A1C] goals."
Woerle HJ, Neumann C, Zschau S, et al.: Impact of fasting
and postprandial glycemia on overall glycemic control in type 2 diabetes:
Importance of postprandial glycemia to achieve target HbA1c levels.
Diab Res Clin Prac 77:280-285, 2007.
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