Morning Hyperglycemic Excursions
Open Access
- 1 April 2002
- journal article
- Published by American Diabetes Association in Diabetes Care
- Vol. 25 (4), 737-741
- https://doi.org/10.2337/diacare.25.4.737
Abstract
OBJECTIVE—To determine whether, over daytime, one or several hyperglycemic excursions exist that can be general failures in the glycemic control of patients with type 2 diabetes. RESEARCH DESIGN AND METHODS—In 200 non–insulin-using patients with type 2 diabetes, diurnal plasma glucose and insulin profiles were studied. Plasma glucose concentrations were measured after an overnight fast (at 8:00 a.m. immediately before breakfast), during the postprandial period (at 11:00 a.m. and 2:00 p.m.), and during the postabsorptive period (at 5:00 p.m., extended postlunch time). RESULTS—In the population considered as a whole, prelunch glucose concentrations (12.0 mmol/l) were found to be significantly increased (P < 0.0001) when compared with those observed at 8:00 a.m. (8.8 mmol/l), at 2:00 p.m. (10.5 mmol/l), and at 5:00 p.m. (8.6 mmol/l). Similar significant excursions (P < 0.0001) in prelunch glucose were observed within subsets of patients selected from the following criteria: 1) body weight, 2) HbA1c, 3) categories of treatment, and 4) residual β-cell function. From the calculation of areas under the daytime glucose curves, the relative contributions of postprandial and fasting glucose to the total glucose increment were found to be similar. CONCLUSIONS—High plasma glucose excursions over morning periods seem to be a permanent failure in non–insulin-using patients with type 2 diabetes, whatever the clinical (BMI), biological (HbA1c), therapeutic, and pathophysiological (residual β-cell function) status. Midmorning glucose testing should be recommended for detecting such abnormalities and for correcting them with appropriate therapies.Keywords
This publication has 21 references indexed in Scilit:
- Report of the Expert Committee on the Diagnosis and Classification of Diabetes MellitusDiabetes Care, 2002
- Standards of Medical Care for Patients With Diabetes MellitusClinical Diabetes, 2002
- Postprandial Blood GlucoseDiabetes Care, 2001
- Comparison of insulin regimens for patients with type 2 diabetesCurrent Opinion in Endocrinology, Diabetes and Obesity, 2000
- How valid is fasting plasma glucose as a parameter of glycemic control in non-insulin-using patients with type 2 diabetes?Diabetes Care, 1999
- Evidence for a circadian rhythm of insulin sensitivity in patients with NIDDM caused by cyclic changes in hepatic glucose productionDiabetes, 1996
- U.K. prospective diabetes study 16. Overview of 6 years' therapy of type II diabetes: a progressive disease. U.K. Prospective Diabetes Study GroupDiabetes, 1995
- Carbohydrate Metabolism in Non-Insulin-Dependent Diabetes MellitusNew England Journal of Medicine, 1992
- Evening Insulin StrategyDiabetes Care, 1990
- Measurement of plasma glucose, free fatty acid, lactate, and insulin for 24 h in patients with NIDDMDiabetes, 1988