Clinical decision making: managing postprandial hyperglycemia.

The primary objective of treating all patients with diabetes is to establish and maintain near-normal blood glucose levels to prevent microvascular and macrovascular complications. The glycated hemoglobin (HbA(1c)) is the accepted standard for monitoring overall glycemic control with treatments and management strategies traditionally targeting fasting and preprandial glucose levels. However, postprandial glucose levels also contribute to HbA(1c), and optimization of glycemic control may also require targeting these values. Exaggerated postmeal glucose excursions are common in patients with diabetes, and postprandial hyperglycemia (PPHG) is an independent risk factor for cardiovascular disease. Regular self-monitoring of blood glucose concentrations (SMBG) at appropriate times can detect PPHG, provide patient feedback regarding meals and lifestyle, and monitor response to therapy. SMBG can also help detect fluctuations in blood glucose levels, which may be an additional risk factor for complications, independent of HbA(1c). New therapeutic options that specifically target postprandial glucose levels may improve overall glycemic control and reduce the risk of microvascular and macrovascular complications.