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Correlation of Fasting Versus Postprandial Plasma Glucose with HbA1c in Chinese Type 2 Diabetic Patients Taking Different Hypoglycemic Agents by Xiang Wang, Fang Wang, Haifeng Wang, Nan Li

Background: Currently, it is not well understood how the contribution of basal versus postprandial plasma glucose changes in the management of type 2 diabetes mellitus (DM) with different treatment regimens. This study aimed to investigate the relationships between glycated hemoglobin (HbA1c) and fasting as well as postprandial blood glucose and to determine how these relationships changed during DM progression in Chinese diabetic patients with different treatment regimens.
Methods: Continuous glucose monitoring was conducted in 228 type 2 DM patients with stable glucose levels. They were divided into five groups according to the HbA1c quintile. The areas under the curve (AUCs) between the monitoring blood glucose curve and the target blood glucose curve (5.6 mmol/L) were measured.
Results: Eighty-six (37.7%) patients were administered with an oral antihyperglycemic drug (OAD), 88 (38.6%) with basal insulin (BI), and 54 (23.7%) with premixed insulin (PI). There was a statistically significant increase in the fasting hyperglycemia contribution in patients with elevated ranges of HbA1c despite the treatment regimen (p < 0.05), and the opposite trend was observed in postprandial hyperglycemia. The contribution from fasting plasma glucose to total hyperglycemic exposure was significantly lower in patients using BI (55.6 ± 17.8%), compared with those using an OAD or PI (61.7 ± 14.2% and 82.2 ± 21.8%, respectively), when HbA1c ≥ 10%.
Conclusions: Optimal glycemic control may be achieved by the appropriate selection of agents that balance fasting and postprandial hyperglycemia. Patients with poorly controlled hyperglycemia may benefit more from a BI regimen by reducing the fasting hyperglycemia contribution.

DOI: 10.7754/Clin.Lab.2017.161220