Bedeutung der postprandialen Blutglukosewerte für das Erreichen von HbA1c Zielwerten
LicenseStandard (Fassung vom 01.10.2008)
OBJECTIVE: HbA1c values reflect overall glycemic exposure over the past 2 - 3 months and are determined by both fasting (FPG) and postprandial plasma glucose (PPG) levels. Cross-sectional studies suggest that attainment of HbA1c goals requires specific targeting of postprandial hyperglycemia. RESEARCH DESIGN AND METHODS: This is a prospective interventional trial to assess the relative contribution of FPG and PPG for achieving recommended HbA1c goals. One hundred and sixty-four patients (90 male and 74 female) with unsatisfactory glycemic control (HbA1c >/= 7.5 %) were enrolled in an individualized forced titration intensified treatment program. RESULTS: After 3 months HbA1c levels decreased from 8.7 +/- 0.1 to 6.5 +/- 0.1 % (p < 0.001); FPG decreased from 174 +/- 4 to 117 +/- 2 mg/dl (p < 0.001); PPG decreased from 224 +/- 4 to 159 +/- 3 mg/dl (p < 0.001) and daylong hyperglycemia (average of premeal, postprandial and bedtime plasma glucose excluding FPG) decreased from 199 +/- 4 to 141 +/- 2 mg/dl (p < 0.0001). Patients´ weight remained unchanged (84.0 +/- 1.4 kg versus 82.9 +/- 1.5kg, p = 0.36). No severe hypoglycemia occurred as defined by DCCT criteria. Only 64 % of patients who achieved FPG targets of < 100 mg/dl also achieved the HbA1c target of < 7 % whereas 94 % of patients who achieved the postprandial target of < 140 mg/dl did. Decreases in PPG accounted for nearly twice as much for the decreases in HbA1c as did decreases in FPG. PPG accounted for approximately 80 % of HbA1c for HbA1c values < 6.2 % and only for about 40 % for HbA1c values above 9.0 %. CONCLUSIONS: Control of fasting hyperglycemia is necessary but usually insufficient for attaining HbA1c goals < 7 %. Control of postprandial hyperglycemia is essential for achieving recommended HbA1c goals.
Subject HeadingsHyperglykämie [GND]