Shaefer Charles, Reid Timothy, DiGenio Andres, Vlajnic Aleksandra, Zhou Rong, Ameer Barbara, Riddle Matthew
University Health Systems, University Hospital, Augusta, GA, USA; University Medical Group, Primary Care, Evans, GA, USA.
Diabetes Metab Res Rev. 2015 Mar;31(3):269-79. doi: 10.1002/dmrr.2606. Epub 2014 Nov 18.
Treatment of postprandial hyperglycemia could be needed when basal insulin added to oral therapy does not maintain glycated haemoglobin (HbA1C ) targets in type 2 diabetes mellitus. Knowing individual and regional patterns of postprandial hyperglycemia in this setting might improve therapeutic decisions.
Patient-level self-monitored blood glucose data were pooled from six studies of insulin glargine for patients with HbA1C ≥ 7.0% after 24 weeks. Percentages of participants with highest daily postprandial blood glucose and greatest postprandial increments after each of the three daily meals were calculated and compared between four geographical regions; USA, Canada, Germany, and other European countries.
For 494 participants (mean age 60.1 years, diabetes duration 9.6 years, and BMI 29.8 kg/m(2) ), mean endpoint HbA1C was 7.8%. On insulin glargine treatment, highest postprandial blood glucose most often occurred post-dinner (44% of participants) and greatest postprandial increments post-breakfast (46% of participants) in all regions. Participants with greatest postprandial increments post-breakfast were older and experienced less HbA1C improvement with insulin glargine than those with greatest postprandial increments after other meals. Post-breakfast and post-dinner postprandial blood glucose was higher in the USA and Canada versus Germany, and in the USA versus Other European countries (all p < 0.05). Postprandial increments after dinner were greater in the USA versus all other regions.
Generally, highest postprandial blood glucose follows dinner and greatest postprandial increments follow breakfast. Variations in patient characteristics and eating patterns might underlie differences both within and between regions. Awareness of regional differences and evaluation of an individual's typical eating pattern might facilitate appropriate prandial therapy.
当在口服治疗基础上加用基础胰岛素仍无法使2型糖尿病患者的糖化血红蛋白（HbA1C）达到目标水平时，可能需要对餐后高血糖进行治疗。了解这种情况下个体和区域的餐后高血糖模式可能会改善治疗决策。
汇总了六项关于甘精胰岛素治疗24周后HbA1C≥7.0%患者的研究中的患者水平自我监测血糖数据。计算并比较了四个地理区域（美国、加拿大、德国和其他欧洲国家）每日餐后血糖最高值和每日三餐后餐后血糖增幅最大的参与者百分比。
对于494名参与者（平均年龄60.1岁，糖尿病病程9.6年，体重指数29.8kg/m²），平均终点HbA1C为7.8%。在甘精胰岛素治疗中，所有区域餐后血糖最高值最常出现在晚餐后（44%的参与者），餐后血糖增幅最大出现在早餐后（46%的参与者）。早餐后餐后血糖增幅最大的参与者年龄较大，与其他餐次餐后血糖增幅最大的参与者相比，使用甘精胰岛素治疗时HbA1C改善较少。与德国相比，美国和加拿大早餐后和晚餐后餐后血糖更高，与其他欧洲国家相比，美国的情况也是如此（所有p<0.05）。与所有其他区域相比，美国晚餐后餐后血糖增幅更大。
一般来说，餐后血糖最高值出现在晚餐后，餐后血糖增幅最大出现在早餐后。患者特征和饮食模式的差异可能是区域内和区域间差异的基础。了解区域差异并评估个体的典型饮食模式可能有助于进行适当的餐时治疗。
