Laboratory of Human Nutrition and Atherosclerosis, Institute of Clinical Research, University of Montpellier I , Montpellier, France.
Diabetes Technol Ther. 2011 Jun;13 Suppl 1:S25-32. doi: 10.1089/dia.2010.0239.
The independent contribution of postprandial glucose (PPG) excursions to the overall glucose exposure and its role in the development of both micro- and macrovascular complications of diabetes remain subject to continuing debate in type 2 diabetes. Discussion continues on whether postprandial hyperglycemia is the main contributor to the overall hyperglycemia in fairly well-controlled individuals, whereas basal hyperglycemia becomes the preponderant contributor in poorly controlled patients. The concern about the role of PPG as a risk factor for diabetes complications is related to the controversial data obtained in individuals with impaired glucose tolerance. It remains, however, that the total glucose exposure as reflected by hemoglobin A1c (HbA1c) levels is an undoubted major vascular risk factor. Excluding the contribution of PPG is nonsensical. In support of this position is the fact that the absolute impact of PPG on HbA1c, expressed as percentage levels of HbA1c, remains constant at 1% across the HbA1c continuum in non-insulin-treated type 2 diabetes patients. This key feature clearly depicts the absolute contribution of PPG in contrast to its relative contribution and better explains why PPG contributes to the excess of glycation with the basal hyperglycemia.
在 2 型糖尿病中，餐后血糖（PPG）波动对整体血糖暴露的独立贡献及其在糖尿病微血管和大血管并发症发展中的作用仍存在争议。关于餐后高血糖是否是血糖控制良好的个体中整体高血糖的主要原因，而基础高血糖在血糖控制不佳的患者中成为主要原因，这一问题仍在讨论中。人们对 PPG 作为糖尿病并发症风险因素的作用存在担忧，这与在糖耐量受损个体中获得的有争议的数据有关。然而，血红蛋白 A1c（HbA1c）水平反映的总血糖暴露仍然是一个毫无疑问的主要血管风险因素。排除 PPG 的贡献是没有意义的。支持这一观点的事实是，在未接受胰岛素治疗的 2 型糖尿病患者的整个 HbA1c 连续体中，PPG 对 HbA1c 的绝对影响（以 HbA1c 的百分比水平表示）保持不变，为 1%。这一关键特征清楚地描绘了 PPG 的绝对贡献，与相对贡献形成对比，并更好地解释了为什么 PPG 会导致基础高血糖时糖化作用的增加。
