What is postprandial hyperglycemia?

From the Guidelines

Postprandial hyperglycemia is an abnormally high blood sugar level that occurs after eating a meal, typically exceeding 140 mg/dL within 1-2 hours after eating, and is a significant concern in diabetes management as it contributes to complications even when fasting blood sugar levels appear controlled. This condition arises when the body cannot effectively process glucose from food due to insufficient insulin production or reduced insulin sensitivity, preventing glucose from efficiently entering cells for energy use. According to the most recent guidelines, such as those outlined in 1, managing postprandial hyperglycemia involves dietary modifications, regular physical activity, and medications like rapid-acting insulin, GLP-1 receptor agonists, or SGLT-2 inhibitors when appropriate.

Key Points in Managing Postprandial Hyperglycemia:

• Dietary modifications: Reducing simple carbohydrates and focusing on high-fiber foods can help manage postprandial glucose spikes.
• Regular physical activity: Especially after meals, can improve insulin sensitivity and help lower postprandial glucose levels.
• Medications: Rapid-acting insulin, GLP-1 receptor agonists, or SGLT-2 inhibitors can be used to manage postprandial hyperglycemia when necessary.
• Monitoring: Blood glucose levels should be monitored after meals to identify and address spikes, which, if left untreated, can damage blood vessels and nerves over time.

Importance of Monitoring and Targeting Postprandial Glucose:

Monitoring postprandial glucose levels is essential for identifying and addressing these spikes. As noted in 1 and 1, postprandial glucose targets should be individualized, but generally, peak postprandial capillary plasma glucose should be less than 180 mg/dL. The management of postprandial hyperglycemia is crucial for preventing diabetes complications, as highlighted in various studies, including those referenced in 1 and 1, which discuss the importance of controlling postprandial glucose excursions to reduce cardiovascular risk and improve outcomes in patients with diabetes.

From the FDA Drug Label

During treatment initiation and dose titration ... one-hour postprandial plasma glucose may be used to determine the therapeutic response to acarbose tablets and identify the minimum effective dose for the patient. The therapeutic goal should be to decrease both postprandial plasma glucose and glycosylated hemoglobin levels to normal or near normal by using the lowest effective dose of acarbose tablets, either as monotherapy or in combination with sulfonylureas, insulin or metformin Postprandial hyperglycemia is an elevation of blood glucose levels after a meal.

• It is a condition where the body is unable to regulate blood sugar levels after eating, leading to high glucose levels.
• Postprandial plasma glucose is used as a measure to determine the therapeutic response to certain medications, such as acarbose tablets, and to identify the minimum effective dose for a patient 2.
• The goal of treatment is to decrease postprandial plasma glucose levels to normal or near normal using the lowest effective dose of medication 2.

From the Research

Definition and Causes of Postprandial Hyperglycemia

• Postprandial hyperglycemia (PPHG) refers to the elevated levels of blood glucose that occur after a meal [ 3 ].
• The causes of PPHG are influenced by several factors, including a rapid flux of glucose from the gut, impaired insulin release, endogenous glucose production by the liver, and peripheral insulin resistance [ 3 ].

Clinical Significance and Complications

• PPHG contributes to the increased risk of both micro- and macrovascular complications in patients with diabetes mellitus [ 3 ].
• Epidemiological studies suggest that PPHG or hyperinsulinaemia are independent risk factors for the development of macrovascular complications of diabetes mellitus [ 4 ].
• Increasing evidence suggests that the postprandial state is a contributing factor to the development of atherosclerosis, and postprandial hyperglycemia is a direct and independent risk factor for cardiovascular disease (CVD) [ 5 ].

Treatment Options

• Several drugs have been developed to target PPHG, including alpha-glucosidase inhibitors, insulin secretagogues, rapid-acting insulin analogs, and amylin analogs [ 3 ].
• Alpha-glucosidase inhibitors, such as acarbose and miglitol, attenuate the rate of absorption of sucrose by acting on the luminal enzymes [ 3 ].
• Newer insulin secretagogues, such as repaglinide and nateglinide, attempt to mimic the physiological release of insulin and thus ameliorate PPHG [ 3 ].
• Rapid-acting insulin analogs, such as insulin lispro, have a faster onset of action and can help to specifically target PPHG [ 4 ].