Aronoff Stephen L
a Endocrine Associates of Dallas, Research Institute of Dallas , Dallas , TX , USA.
Postgrad Med. 2017 Mar;129(2):231-241. doi: 10.1080/00325481.2017.1285191. Epub 2017 Feb 8.
While glycemic control is routinely assessed using HbA1c and fasting glucose measures, postprandial glucose (PPG) is also an important contributor of overall glycemia. Furthermore, PPG excursions have been linked to complications of diabetes. This review examines the effects of glucose-lowering therapies (including treatments administered at mealtime) on postprandial hyperglycemia in patients with type 2 diabetes. A PubMed search was conducted to identify clinical studies of treatments for mealtime glucose control in type 2 diabetes. Different treatments may have comparable effects on HbA1c but varying effects on PPG control and glucose fluctuations. Older classes of oral glucose-lowering treatments administered at mealtime to lower PPG include meglitinides and α-glucosidase inhibitors. Injectable therapies, including prandial insulin analogs, glucagon-like peptide-1 receptor agonists (GLP-1RAs), and the amylin analog pramlintide, all effectively target postprandial hyperglycemia. Compared with longer-acting GLP-1RAs, short-acting GLP-1RAs, such as exenatide twice daily and lixisenatide once daily, have a greater effect on PPG control, which is primarily mediated by a more pronounced effect on delayed gastric emptying. Dipeptidyl peptidase-4 inhibitors and sodium-glucose cotransporter 2 inhibitors also reduce postprandial hyperglycemia. To achieve more physiologically normal glycemic control, choice of therapy should ideally aim to address daily glucose fluctuations, including hyperglycemic peaks and hypoglycemic troughs, and long-term glycemic control.
虽然通常使用糖化血红蛋白（HbA1c）和空腹血糖测量值来评估血糖控制情况，但餐后血糖（PPG）也是总体血糖水平的重要组成部分。此外，餐后血糖波动与糖尿病并发症有关。本综述探讨了降糖治疗（包括进餐时给予的治疗）对2型糖尿病患者餐后高血糖的影响。通过在PubMed上检索，以确定有关2型糖尿病进餐时血糖控制治疗的临床研究。不同的治疗方法对HbA1c可能有相似的效果，但对餐后血糖控制和血糖波动的影响各不相同。以往用于降低餐后血糖的进餐时口服降糖药物包括格列奈类和α-葡萄糖苷酶抑制剂。注射用疗法，包括餐时胰岛素类似物、胰高血糖素样肽-1受体激动剂（GLP-1RAs）和胰淀素类似物普兰林肽，均能有效针对餐后高血糖。与长效GLP-1RAs相比，短效GLP-1RAs，如每日两次的艾塞那肽和每日一次的利司那肽，对餐后血糖控制的效果更佳，这主要是通过对胃排空延迟产生更显著的作用来介导的。二肽基肽酶-4抑制剂和钠-葡萄糖协同转运蛋白2抑制剂也可降低餐后高血糖。为了实现更接近生理状态的血糖控制，治疗方法的选择理想情况下应旨在解决每日血糖波动问题，包括高血糖峰值和低血糖谷值，以及长期血糖控制。
