Relationship of glycated hemoglobin, and fasting and postprandial hyperglycemia in type 2 diabetes mellitus patients in Malaysia

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Lim, Lee Ling ; Brnabic, Alan JM ; Chan, Siew Pheng ; Ibrahim, Luqman ; Paramasivam, Sharmila Sunita ; Ratnasingam, Jeyakantha ; Vethakkan, Shireene Ratna ; Tan, Alexander Tong Boon (2016)
  • Publisher: John Wiley and Sons Inc.
  • Journal: Journal of Diabetes Investigation, volume 8, issue 4, pages 453-461 (issn: 2040-1116, eissn: 2040-1124)
  • Related identifiers: doi: 10.1111/jdi.12596, pmc: PMC5497026
  • Subject: Original Article | Epidemiology | Postprandial hyperglycemia | Continuous glucose monitoring | Articles | Fasting hyperglycemia
    mesheuropmc: endocrine system diseases | nutritional and metabolic diseases

Abstract Aims/Introduction Studies on the relative contributions of fasting and postprandial hyperglycemia (FH and PPH) to glycated hemoglobin (HbA1c) in patients with type 2 diabetes have yielded inconsistent results. We aimed to assess the relationship by using continuous glucose monitoring in a multi‐ethnic cohort. Materials and Methods A total of 100 adults with type 2 diabetes were assessed with 6‐day continuous glucose monitoring and HbA1c. Area under the curve (AUC) ≥5.6 mmol/L was defined as AUCTOTAL. AUC equal to or greater than each preprandial glucose for 4‐h duration was defined as AUCPPH. The total PPH (AUCTPPH) was the sum of the various AUCPPH . The postprandial contribution to overall hyperglycemia was calculated as (AUCTPPH / AUCTOTAL) × 100%. Results The present study comprised of Malay, Indian, and Chinese type 2 diabetes patients at 34, 34 and 28% respectively. Overall, the mean PPH significantly decreased as HbA1c advanced (mixed model repeated measures adjusted, beta‐estimate = −3.0, P = 0.009). Age (P = 0.010) and hypoglycemia (P = 0.006) predicted the contribution difference. In oral antidiabetic drug‐treated patients (n = 58), FH contribution increased from 54% (HbA1c 6–6.9%) to 67% (HbA1c ≥10%). FH predominance was significant in poorly‐controlled groups (P = 0.028 at HbA1c 9–9.9%; P = 0.015 at HbA1c ≥10%). Among insulin users (n = 42), FH predominated when HbA1c was ≥10% before adjustment for hypoglycemia (P = 0.047), whereas PPH was numerically greater when HbA1c was <8%. Conclusions FH and PPH contributions were equal in well‐controlled Malaysian type 2 diabetes patients in real‐world practice. FH predominated when HbA1c was ≥9 and ≥10% in oral antidiabetic drug‐ and insulin‐treated patients, respectively. A unique observation was the greater PPH contribution when HbA1c was <8% despite the use of basal and mealtime insulin in this multi‐ethnic cohort, which required further validation.
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