To investigate the real postprandial plasma glucose status level and the relation between postprandial plasma glucose, fasting plasma glucose and A1c as well as diabetic complications in patients with type 2 diabetes mellitus. Subjects and methods: The study was descriptive and cross-sectional with the population of 125 people with type 2 diabetes mellitus. All participants were examined and measured postprandial plasma glucose, fasting plasma glucose and A1c. Results: Mean postprandial plasma glucose was 13.41 mmol/L and 77.6% of participants had poor postprandial plasma glucose control. When A1c was less than 7%, postprandial plasma glucose makes a predominant contribution to an accumulative A1c in comparison to fasting plasma glucose. Participants with poor postprandial plasma glucose control were more likely to have microvascular complications than those with good postprandial plasma glucose control. Conclusion: The present study provided new evidence of relation of 2-hour postprandial plasma glucose to A1c and some diabetic complications in patients with type 2 diabetes mellitus.
Trang 1EVALUATION OF 2-HOUR POSTPRANDIAL PLASMA
GLUCOSE LEVEL AND ITS RELATION TO A1c AND SOME DIABETIC COMPLICATIONS IN PATIENTS
WITH TYPE 2 DIABETES MELLITUS
Nguyen Tien Son 1 ; Le Van Quan 1
SUMMARY
Objectives: To investigate the real postprandial plasma glucose status level and the relation
between postprandial plasma glucose, fasting plasma glucose and A1c as well as diabetic
complications in patients with type 2 diabetes mellitus Subjects and methods: The study was
descriptive and cross-sectional with the population of 125 people with type 2 diabetes mellitus
All participants were examined and measured postprandial plasma glucose, fasting plasma
glucose and A1c Results: Mean postprandial plasma glucose was 13.41 mmol/L and 77.6% of
participants had poor postprandial plasma glucose control When A1c was less than 7%,
postprandial plasma glucose makes a predominant contribution to an accumulative A1c in
comparison to fasting plasma glucose Participants with poor postprandial plasma glucose
control were more likely to have microvascular complications than those with good postprandial
plasma glucose control Conclusion: The present study provided new evidence of relation of 2-hour postprandial plasma glucose to A1c and some diabetic complications in patients with
type 2 diabetes mellitus
* Keywords: Type 2 diabetes mellitus; Postprandial plasma glucose; Fasting plasma glucose
INTRODUCTION
Diabetes is a group of metabolic
diseases which characterized by chronic
hyperglycemia Diabetic prevalence
has increased sharply recently (about
592 million people with diabetes) [1]
Multifactor control is a pivotal factor in
diabetic achievement goals, and among
them, glycemic controls are of great
concerns, including A1c, fasting plasma
glucose (FPG) [2] Physicians regularly
aim to decrease A1c and FPG and neglect
to control PPG [1] In clinical practice, there are patients who achieve FPG goal but not A1c [2, 3] Some studies pointed out that it was the increase of PPG that makes a contribution to the increase of A1c and diabetic complications as well [1, 2, 4,
5, 9] In the current analysis, we aimed:
To survey the real PPG control conditions and its relation between PPG, FPG and A1c as well as diabetic complications in patients with type 2 diabetes
1 103 Military Hospital
Corresponding author: Le Van Quan (levanquan2002@yahoo.com)
Trang 2SUBJECTS AND METHODS
1 Subjects
145 patients with type 2 diabetes
mellitus (T2D) were enrolled in our study
They were treated at Department of
Rheumatology and Endocrinology, 103 Military
Hospital They met the ADA 2014 criteria
for diabetes mellitus [2, 10], WHO 1985
for type 2 diabetes (T2D) and signed the
Informed Consent Form We further excluded
20 people with T2D who were treated with
insulin The present study was conducted
from June 2016 to December 2016
2 Methods
* Design research: Descriptive and
cross-sectional
* Study procedure:
- Clinical characteristics: Data were
collected at the first-time participants met
researchers, including age, gender, family
history, participant history, disease duration,
height, weight, waist circumstance, blood
pressure, and paraclinical profile, such as
whole blood count, lipid profile, BUN,
creatinine, microalbuminuria
- Glucose profile: Measurements of
glycemic profile were performed at
Department of Biochemistry, 103 Military
Hospital, which measured glycemic profile
at fasting states on the second day of
hospital administration including FPG,
PPG, A1c and C-peptide All blood
samples of glucose profile were taken at
the same time each participant
- Laboratory analyses: Blood samples
taken at the clinical examinations were
sent to laboratory at Department of
Biochemistry, 103 Military Hospital
Samples for determinations of A1c were
analyzed with HPLC (Roche A1c) A1c reflects the average blood glucose over the prior of 8 to 12 weeks Accordingly, A1c were used as outcome variables PPG samples were taken after participants‟ breakfast 2 hours and we assigned them with 2-hour PPG After at least 8 hours of fasting, participants were drawn blood for FPG samples Both PPG and FPG were sent to laboratory within
30 minutes and measured with glucose oxidase method
Insulin resistance was calculated with HOMA2 calculator (downloaded from https://www.dtu.ox.ac.uk/homacalculator/)
* Statistical analyses:
Linear regression analysis was used to estimate the correlations of FPG, PPG as well as glycemic variability (FPG and PPG) with A1c and PPG with HOMA2-IR Analyses were performed without adjustment for age, sex, BMI
We then calculated the proportion of variables in contribution to A1c explained
by the following categories: FPG, PPG Firstly, we calculated the association between A1c and each of the two variables (FPG and PPG) Because the two variables to some extent were correlated to A1c, and then, we calculated the distribution to A1c of each variables using the equation:
A1c = aPPG + bFPG + c
Contributions of PPG to A1c = a/(a+b) Contributions of FPG to HbA1c = b/(a+b) Statistical analyses were performed in SPSS 18.0 A two-sided p (less than or equal to 0.05) was used as a criterion for statistical significance in all analyses
Trang 3RESULTS
1 General characteristics
Table 1:
Age (years)
Gender
Disease duration (years)
Abnormalitites on ECG and
cardiac sonography
PPG (mmol/L)
Table 1 showed the clinical characteristics of the study populations at baseline There were the same proportions of male and female sex, and the majority of participants were > 60 year old Within patients with T2D, MAU accounted for highest percentage of all complications surveyed Though mean FPG was not higher than target for FPG control, mean of A1c (%) still remained high Nearly 80% of participants with T2D controlled PPG poorly and the mean of PPG was 13.41 mmol/L which exceeded the target for PPG according to ADA 2018
Trang 4Figure 1: PPG control grades and diabetic complications
Participants with poor PPG control were likely to suffer from microvascular complications (such as, microalbuminuria and diabetic retinopathy with OR = 1.99 and 1.51, respectively) though there were no statistical significances (p > 0.05)
2 Relationship between glycemic measures and A1c
Table 2: PPG control and A1c control grades
Table 3: PPG control and A1c control grades stratifying by FPG control grades
Indices
PPG
Within the good FPG control group, there were up to 61% with poor PPG control
To have an insight on the distributions of each variables (FPG and PPG) to A1c, we found
0
Changes on ECG and
cardiac sonography
MAU
Diabetic
retinopathy
1.23
1.99
1.51
Trang 5that the role of each variables varied from different A1c gaps and the lower A1c was,
the higher amount of distributions to A1c due to PPG (A1c < 7%) (table 5 and fig.2)
Table 4: Distributions of glycemic variables to A1c
Figure 2:
DISCUSSION
According to UKPDS, each 1% of A1c
reduction could lead to 21% of mortal rate
reduction [9] In our study, up to 77% of
participants poorly controlled PPG, which
showed that there was an inappropriate
attention to the role of PPG Theoretically,
blood glucose is mainly supplied to
human body after meals, while FPG only
accounts for small duration of time (4 - 5
hours estimated) before breakfast [8]
When put PPG control into consideration,
we found that there were 28 participants
with poor A1c control (> 7.5%), even
though they had an acceptable to good FPG control To investigate clearly about this fact, we found that in this special group, there were up to 23 people with poor PPG control These results were
consistent with previous studies [1, 13]
A1c reflexes an estimated average blood glucose over a 3-month period Due
to the fluctuation of blood glucose after meals, many previous studies had tried to find out the role of PPG and FPG to A1c [2, 3, 13] and they pointed out there was a relation between PPG, FPG and A1c but there were no clear evidence for the role
Trang 6of each variables (FPG and PPG) to A1c
In our study, we stratified A1c of all
participants into 3 categories: less than
7%, 7 to 9% and above 9% and we found
that 63% of accumulative A1c due to PPG
if A1c < 7%, which was sustainable with
most of recent studies [8] These results
denoted that to get A1c target control,
only good FPG control was not appropriate,
which consistent with other studies [7, 8]
Whilst some studies figured out that FPG
had a strong correlation to macrovascular
complications, PPG tended to relate to
microvascular complications in patients
with T2D In our study, participants with
poor PPG control were likely to suffer
from microvascular complications (such as
microalbuminuria and diabetic retinopathies,
OR = 1.99 and 1.51 respectively, but both
p > 0.05) Some hypotheses were created
to explain this fact After meals, the high
fluctuation of PPG could lead to the changes
of oxidative agents and decrease in NO
secretion into circulation and VCAM-1,
ICAM-1, E-selectin especially when PPG
> 10 mmo/L [4] In Japan, a recent study
has suggested that high PPG was an
independent risk factor for diabetic retinopathy
due to endothelium disorders [9]
There were also some limitations in
our study, due to A1c is accumulative
blood glucose for about 3 months, we
need to take blood samples for PPG and
FPG more times during the baseline visits
of each participants and after 3 months
The number of diabetic complications was
too small (3 complications) but these
complications were common in patients
with T2D
CONCLUSION
In our study, patients with T2D mainly cared about FPG and A1c and the vast majority of patients had poor PPG controls, which more likely led to microvascular diabetic complications When a physician judges glycemic control in patients with T2D, he/she should take PPG into
consideration if A1c > 7 %
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