Treating Postprandial Hyperglycemia Does Not Appear to Delay Progression of Early Type 2 Diabetes

“…This observation is reinforced by the fact that the carbohydrate intakes were similar in these two early subgroups. While these results suggest that excessive postprandial glucose increments should be managed earlier in the course of the disease to achieve A1C Ͻ6.5%, amelioration of postprandial excursions cannot be assumed to delay the progression of the disease (28).…”

Section: Conclusion -The Results Frommentioning

confidence: 89%

The Loss of Postprandial Glycemic Control Precedes Stepwise Deterioration of Fasting With Worsening Diabetes

Colette²,

et al. 2007

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OBJECTIVE -The aim of the study was to determine whether the loss of fasting and postprandial glycemic control occurs in parallel or sequentially in the evolution of type 2 diabetes.RESEARCH DESIGN AND METHODS -In 130 type 2 diabetic patients, 24-h glucose profiles were obtained using a continuous glucose monitoring system. The individuals with type 2 diabetes were divided into five groups according to A1C levels: 1 (Ͻ6.5%, n ϭ 30), 2 (6.5-6.9%, n ϭ 17), 3 (7-7.9%, n ϭ 32), 4 (8 -8.9%, n ϭ 25), and 5 (Ն9%, n ϭ 26). The glucose profiles between the groups were compared. The overall glucose concentrations for the diurnal, nocturnal, and morning periods, which represent the postprandial, fasting, and the dawn phenomenon states, respectively, were also compared.RESULTS -Glucose concentrations increased steadily from group 1 to 5 in a stepwise manner. The initial differences in mean glucose concentrations reaching statistical significance occurred 1) between groups 1 and 2 (6.4 vs. 7.7 mmol/l, P ϭ 0.0004) for daytime postprandial periods, followed by differences; 2) between groups 2 and 3 (7.5 vs. 9.3 mmol/l, P ϭ 0.0003) for the morning periods (dawn phenomenon); and finally 3) between groups 3 and 4 (6.3 vs. 8.4 mmol/l, P Ͻ 0.0001) for nocturnal fasting periods.CONCLUSIONS -The deterioration of glucose homeostasis in individuals with type 2 diabetes progressed from postprandial to fasting hyperglycemia following a three-step process. The first step related to the three diurnal postmeal periods considered as a whole, the second step occurred during the morning period, and the third and final step corresponded to sustained hyperglycemia over the nocturnal fasting periods. Such a description of the key stages in the evolution of type 2 diabetes may be of interest for implementing antidiabetes treatment. Diabetes Care 30:263-269, 2007T he steady decline in the quality of glucose homeostasis (1) as observed in type 2 diabetes results from an increasing defect (2) in both insulin sensitivity and secretion (3). The data from the UK Prospective Diabetes Study indicate that the gradual increase in both A1C levels and fasting glucose concentrations is mainly due to a relentless linear deterioration in ␤-cell function from the time of diagnosis. In contrast, the years that precede the development of type 2 diabetes are characterized by a progressive decline in both insulin action and defects in the early phase of the insulin secretion (4,5). Such abnormalities lead to a progressive transition from normal glucose tolerance to impaired glucose tolerance and finally to frank type 2 diabetes. As impaired glucose tolerance is acknowledged as a prediabetic stage, it has been postulated that losses of postprandial glucose control occur before deterioration in fasting glucose concentration (4,6,7). In a previous study (8), we have demonstrated that postprandial glucose increments are predominant contributors to the overall hyperglycemia in patients with an A1C Ͻ7.3%, while fasting increments represent the major contributor to worsenin...

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“…Taking steps to reduce PPG is recommended by the American Diabetes Association to limit complications of diabetes [20] , and the therapeutic value of hypoglycemic agents that target PPG in non-diabetic populations has been demonstrated in several clinical trials [8,21] . Considering the accumulating evidence supporting an antiglycemic effect of vinegar, the medicinal use of vinegar at mealtime may be considered alongside other dietary manipulations currently recommended for reducing PPG: monitoring total grams of dietary carbohydrate and utilizing the glycemic index of individual food items when preparing meal plans.…”

Section: Discussionmentioning

confidence: 99%

Examination of the Antiglycemic Properties of Vinegar in Healthy Adults

Johnston¹,

Steplewska²,

Long³

et al. 2010

Ann Nutr Metab

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Background: Vinegar reduces postprandial glycemia (PPG) in healthy adults. This study investigated the vinegar dosage (10 vs. 20 g), timing (during mealtime vs. 5 h before meal) and application (acetic acid as vinegar vs. neutralized salt) for reducing PPG. Methods: Four randomized crossover trials were conducted in adults (n = 9–10/trial) with type 2 diabetes (1 trial) or without diabetes (3 trials). All trials followed the same protocol: a standardized meal the evening prior to testing, an overnight fast (>10 h) and 2-hour glucose testing following consumption of a bagel and juice test meal (3 trials) or dextrose solution (1 trial). For each trial, PPG was compared between treatments using area-under-the-curve calculations 120 min after the meal. Results: Two teaspoons of vinegar (∼10 g) effectively reduced PPG, and this effect was most pronounced when vinegar was ingested during mealtime as compared to 5 h before the meal. Vinegar did not alter PPG when ingested with monosaccharides, suggesting that the antiglycemic action of vinegar is related to the digestion of carbohydrates. Finally, sodium acetate did not alter PPG, indicating that acetate salts lack antiglycemic properties. Conclusions: The antiglycemic properties of vinegar are evident when small amounts of vinegar are ingested with meals composed of complex carbohydrates. In these situations, vinegar attenuated PPG by ∼20% compared to placebo.

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Treating Postprandial Hyperglycemia Does Not Appear to Delay Progression of Early Type 2 Diabetes

Cited by 43 publications

References 23 publications

A study of the effects of acarbose on glucose metabolism in patients predisposed to developing diabetes: the Dutch acarbose intervention study in persons with impaired glucose tolerance (DAISI)

A study of the effects of acarbose on glucose metabolism in patients predisposed to developing diabetes: the Dutch acarbose intervention study in persons with impaired glucose tolerance (DAISI)

The Loss of Postprandial Glycemic Control Precedes Stepwise Deterioration of Fasting With Worsening Diabetes

Examination of the Antiglycemic Properties of Vinegar in Healthy Adults

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