Monnier Louis, Colette Claude, Owens David R
Department of Metabolic Diseases, Lapeyronie Hospital, Montpellier, France.
Diabetes Metab Res Rev. 2009 Jul;25(5):393-402. doi: 10.1002/dmrr.962.
The high incidence of atherosclerosis and cardiovascular disease (CVD) is the leading cause of morbidity and mortality among patients with diabetes. Evidence is accumulating that postprandial hyperglycaemia is an independent risk factor for diabetes-associated complications and mortality, and that worsening diabetes control is characterized by postprandial glucose (PPG) deterioration preceding an impairment in fasting glucose levels. Postprandial and general glucose fluctuations play a major role in activating oxidative stress, leading to the endothelial dysfunction, one of the mechanisms responsible for vascular complications. Therefore, the management of PPG is key for any strategy used in the monitoring and treatment of diabetes. We recommend that any strategy aimed at controlling the glycaemic disorders associated with type 2 diabetes, and limiting the risk of complications, should target the 'glucose tetrad', which comprises the following components: HbA(1c), fasting and postprandial plasma glucose, and markers of glycaemic variability, such as the mean amplitude of glycaemic excursions (MAGE) index. This brings together, in a simple, unified concept, the conventional markers (HbA(1c) and fasting glucose) and the more recently recognized markers of glycaemic control (PPG excursions and acute glycaemic variability).
动脉粥样硬化和心血管疾病（CVD）的高发病率是糖尿病患者发病和死亡的主要原因。越来越多的证据表明，餐后高血糖是糖尿病相关并发症和死亡的独立危险因素，且糖尿病控制恶化的特征是空腹血糖水平受损之前餐后血糖（PPG）恶化。餐后和总体血糖波动在激活氧化应激中起主要作用，导致内皮功能障碍，这是血管并发症的发病机制之一。因此，PPG的管理是糖尿病监测和治疗中任何策略的关键。我们建议，任何旨在控制与2型糖尿病相关的血糖紊乱并限制并发症风险的策略，都应以“血糖四重奏”为目标，其包括以下组成部分：糖化血红蛋白（HbA1c）、空腹和餐后血浆葡萄糖，以及血糖变异性标志物，如血糖波动幅度平均值（MAGE）指数。这以一个简单、统一的概念，将传统标志物（HbA1c和空腹血糖）和最近才被认识的血糖控制标志物（PPG波动和急性血糖变异性）结合在一起。
