Postprandial hyperglycemia: Why do we care about it? What should we do?

There is increasing evidence that elevated postprandial plasma glucose (PPG) exerts a more deleterious effect on the vascular system than elevation of fasting plasma glucose (FPG). In particular, individuals with normal FPG but impaired glucose tolerance (IGT) have significantly increased risk of cardiovascular events. With the recognition of the importance of PPG and the availability of new pharmacologic options, management of diabetes will shift to greater attention to PPG levels. There are many approaches to reduction of PPG; dietary management and promotion of exercise are very effective. Sulfonylureas, meglitinides, metformin, thiazolidinediones, and disaccharidase inhibitors all counteract PPG elevation. The development of glucagon-like peptide-1 (GLP-1) agonists such as exendin and dipeptidyl peptidase IV inhibitors offers a new approach to suppression of PPG elevation. New semisynthetic insulin analogues permit a more aggressive response to post-prandial glucose elevation, with lower risk of hypoglycemia, than with regular insulin. The advent of accurate continuous glucose monitoring will facilitate the treatment of post-prandial hyperglycemia.