Targeting prandial hyperglycemia: how important is it and how best to do this?

The contribution of postprandial glucose (PPG) excursions to the overall hyperglycemia of patients with type 2 diabetes depends on the degree of diabetic control. PPG is a major contributor in patients with hemoglobin A(1c) (HbA(1c)) levels below 7.3%, whereas the contribution of fasting plasma glucose (FPG) is preponderant in poorly controlled patients. In addition, the loss of postprandial glycemic control precedes stepwise degradation of fasting with worsening diabetes. As a consequence, monitoring after meals is particularly important in patients with HbA(1c) levels ranging from 6.5% to 8%. In such patients, targeting PPG below 140 mg/dL should be one of the main objectives to achieve HbA(1c) less than 6.5%. The new hypoglycemic agents, such as the glucagon-like peptide-1 analogues and the dipeptidyl peptidase-4 inhibitors which have a gluco-dependent insulinotropic effect, should normally reinforce our therapeutic armamentarium for achieving the glycemic targets that should include the three components of the glucose triad: HbA(1c), FPG, and PPG.