Prediction of Postprandial Glycemic Exposure

Abstract

OBJECTIVE -To determine the best predictors of total postprandial glycemic exposure and peak glucose concentrations in nondiabetic humans. RESEARCH DESIGN AND METHODS -Data from 203 nondiabetic volunteers who ingested a carbohydrate-containing mixed meal were analyzed.RESULTS -Fasting glucose and insulin concentrations were poor predictors of postprandial glucose area above basal (R 2 ϭ ϳ0.07, P Ͻ 0.001). The correlation was stronger for 2-h glucose concentration (R 2 ϭ 0.55, P Ͻ 0.001) and improved slightly but significantly (P Ͻ 0.001) with the addition of fasting glucose, insulin, age, sex, and body weight to the model (r 2 ϭ 0.58). The 2-h glucose concentration also predicted the peak glucose concentration (R 2 ϭ 0.37, P Ͻ 0.001) with strength of the prediction increasing (P Ͻ 0.001) modestly with the addition of fasting glucose, insulin, age, sex, and body weight to the model (R 2 ϭ 0.48, P Ͻ 0.001). On the other hand, addition of measures of body function and composition did not improve prediction of total glycemic exposure or peak glucose concentration.CONCLUSIONS -Isolated measures of fasting or 2-h glucose concentrations alone or in combination with more complex measures of body composition and function are poor predictors of postprandial glycemic exposure or peak glucose concentration. This may explain, at least in part, the weak and at times inconsistent relationship between these parameters and cardiovascular risk. Diabetes Care 29:2708 -2713, 2006B oth fasting and postprandial hyperglycemia are associated with increased cardiovascular risk (1-11). The mechanism(s) of this risk remains an area of active investigation. Short-term studies in animals and humans have shown that elevated glucose concentrations can impair endothelial function, increase oxidative stress, stimulate intracellular signaling, and alter protein structure and function (12)(13)(14)(15)(16)(17). Virtually all studies that have evaluated the relationship between postprandial hyperglycemia and cardiovascular complications have measured the glucose concentration 2 h after a glucose challenge (1-11). This time point presumably was chosen because it also is used during a traditional glucose tolerance test to classify individuals according to whether they have diabetes, impaired glucose tolerance, or normal glucose tolerance (18). However, the extent to which measurement of a single value 2 h after a carbohydrate challenge reflects the postprandial glucose area above basal, and thus the total exposure of tissues to elevated glucose concentrations, has received limited attention and therefore is the focus of the present study. Furthermore, because studies suggest that there may be a glucose threshold that when exceeded, albeit briefly, triggers a cascade of events that could ultimately affect cell function (19,20), peak postprandial glucose concentrations also may modulate subsequent cardiovascular risk.A standard oral glucose tolerance test (OGTT) entails ingestion of 75 g of glucose and measurement of two glucose concentrations: fasting...

Time in Tight Glucose Range in Type 1 Diabetes: Predictive Factors and Achievable Targets in Real-World Users of the MiniMed 780G System

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Generalised stochastic model for characterisation of subcutaneous glucose time series

“…Postprandial (after a meal) glucose test are often performed to monitor the control of diabetes patients. However, according to Cohen et al [3], measures of 2-h glucose concentrations alone or combined with fasting concentration, body composition etc. are poor predictors of glycaemic exposure.…”