Is Postprandial Glucose Control Important? Is It Practical In Primary Care Settings?

There has been much debate about the effect of postprandial glucose levels on diabetes outcomes and the necessity of treating postprandial hyperglycemia in patients with type 2 diabetes. Current recommendations of the American Diabetes Association (ADA), which have been used predominantly in the United States, present goals for fasting/preprandial and bedtime glucose levels but do not define a target for postprandial glucose.1 The ADA guidelines also present a glycated hemoglobin (A1C) goal of <7%, with “additional action suggested” when A1C is >8%. (See Table 1.) The International Diabetes Federation (IDF) and the American College of Endocrinology (ACE) have each published guidelines that define targets for both fasting/preprandial and 2-h postprandial blood glucose and present ≤6.5% as their A1C goal for glycemic control.2,3 (See Table 1.) Many clinicians argue that these new guidelines are necessary in order to address the significant and growing incidence of microvascular and macrovascular complications caused by poorly controlled diabetes and to clear up confusion among health care providers regarding glycemic targets. Other clinicians, however, fear that the new targets may be unrealistic and even unsafe because they carry an increased risk of hypoglycemia. The latest study of American adults (>20 years of age) with diabetes revealed that ~37% had A1C concentrations >8%; 14% had concentrations >10%.4 These findings support the results of a recent, unpublished survey of 100 primary care providers in which ~58% of respondents