Endocrine Abstracts

Treatments of hyperglycaemia have mostly focussed on targeting fasting glucose. These include Metformin, most sulphonylureas and conventional insulin therapy and, more recently, the glitazones. However, management of postprandial hyperglycaemia in day-to-day practice in both type 1 and type 2 diabetes is now becoming clinically relevant for a number of reasons.

There is now robust evidence in women with gestational diabetes that specifically targeting postprandial glucose confers greater benefit in HbA1c lowering and the pregnancy outcome. In type 1 diabetes, the new short-acting analogues have benefits over conventional soluble insulin in managing postprandial hyperglycaemia. In type 2 diabetes, the prandial glucose regulators such as Repaglinide and Nateglinide also specifically target post-prandial glucose and appears to have other clinical benefits in terms of reduced risk of hypoglycaemia and weight gain compared to conventional sulphonylureas.

There is emerging epidemiological evidence in patients with abnormal glucose tolerance that post-challenge glucose is specifically associated with adverse long-term outcomes. However, whether specifically targeting postprandial glucose will improve outcomes for patients is not yet proven, but is being examined in large prospective outcome studies.