The rationale for paired pre- and postprandial self-monitoring of blood glucose: The role of glycemic variability in micro- and macrovascular risk
University of Rochester School of Medicine, Rochester, NY 14642, USA. <> Current Medical Research and Opinion
(Impact Factor: 2.65).
09/2007; 23(8):1791-8. DOI: 10.1185/030079907X210660
Decisions regarding diabetes management traditionally have been driven by the results of fasting plasma glucose measurement or measurement of glycosylated hemoglobin (A1C), yet glycemic control remains far from optimal in many individuals with diabetes. Mounting evidence implicates glycemic variability, manifested predominantly as postprandial glycemic spikes, as a key factor in the development of macrovascular complications. Recent studies suggest that newer therapies specifically targeting postprandial hyperglycemia can significantly reduce postprandial glucose levels and improve overall glycemic control.
A Medline search was performed using the term 'postchallenge' or 'postprandial', together with glucose or diabetes. After excluding review articles and case studies, we reviewed primary articles, meta-analyses, and references therein and selected those that best addressed this topic. Selection bias may be considered a potential limitation of this approach.
Although not conclusively demonstrated by prospective studies, a wealth of evidence suggests that postprandial hyperglycemia should not be ignored as an important target for preventing complications of diabetes.
Improved detection and management of postprandial hyperglycemia and glycemic variability is necessary to optimize glycemic control. Meal-based self-monitoring of blood glucose (SMBG) has been shown to improve glycemic control as part of a comprehensive management strategy by helping patients understand the effects of food choices, physical activity, and medications on blood glucose concentrations. SMBG can also help healthcare professionals recognize postprandial hyperglycemia, guide therapeutic adjustments and receive more timely feedback regarding medication changes. The arrival of new therapies that specifically target postprandial hyperglycemia offer healthcare professionals the opportunity to optimally manage diabetes.
Available from: Edelmiro Menéndez
Available from: glycomark.com
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ABSTRACT: 1,5-anhydroglucitol (1,5-AG) is a validated marker of short-term glycemic control. It is a metabolically inert polyol that competes with glucose for reabsorption in the kidneys. Otherwise stable levels of 1,5-AG are rapidly depleted as blood glucose levels exceed the renal threshold for glucosuria. 1,5-AG more accurately predicts rapid changes in glycemia than hemoglobin A1C (A1C) or fructosamine. It is also more tightly associated with glucose fluctuations and postprandial glucose. Thus, 1,5-AG may offer complementary information to A1C. This review will summarize the limitations of current methods of assessing glycemic control, assess the data to support 1,5-AG as a glycemic marker and highlight the scenarios by which 1,5-AG may fill the gap in assessing glycemic control.
Available from: Stuart T Haines
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ABSTRACT: To summarize the role, benefits, and risks of continuous subcutaneous insulin infusion (CSII) therapy for treating diabetes.
A literature search was conducted in Medline (1996 to July 2008) using the search terms intensive insulin therapy, insulin pump, and continuous subcutaneous insulin infusion. Reference lists from comprehensive review articles were also used to identify additional original research publications.
Review articles and studies evaluating the role, benefits, and risks of CSII.
More than 300,000 individuals use CSII to treat diabetes. Many experts believe that CSII is the best insulin delivery method for highly motivated patients with type 1 diabetes who are technologically savvy and have the means to pay for the device and infusion sets. CSII is also useful for patients with type 2 diabetes who require multiple daily injections and experience wide fluctuations in blood glucose throughout the day or who experience severe hypoglycemia. A variety of CSII systems are currently available. All CSII systems provide precise insulin delivery throughout the day and improve the accuracy of bolus dose calculations, thereby achieving improved glycemic control with less frequent and severe hypoglycemic episodes. Patients who choose CSII report improved quality of life. Potential risks associated with CSII include mechanical problems leading to diabetes ketoacidosis, infections at the infusion site, hypoglycemia, and lipodystrophy.
CSII is an attractive treatment option for many patients with diabetes. Given the widespread use of CSII, all health professionals should be familiar with the basic features of insulin pump technology, the potential risks and benefits of CSII, and how to troubleshoot common problems.
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