What are the indications of increased 2-hour postprandial (2h pp) glucose in Diabetes Mellitus (DM) patients?

From the Guidelines

Increased 2-hour postprandial (2h PP) blood glucose levels in diabetes mellitus (DM) patients indicate poor glycemic control and potential need for treatment adjustment, with a primary indication being a 2h PP glucose reading above 180 mg/dL (10 mmol/L), as recommended by the most recent guidelines 1. The primary indication for increased 2h PP glucose is a reading above 180 mg/dL (10 mmol/L), which exceeds the target recommended for most diabetic patients. This elevation suggests that the current treatment regimen is insufficient to manage glucose excursions after meals. Some key points to consider in the management of postprandial hyperglycemia include:

• Persistent high postprandial glucose contributes to elevated HbA1c levels and increases the risk of diabetic complications including cardiovascular disease, retinopathy, nephropathy, and neuropathy.
• Treatment modifications may include adjusting meal-time insulin doses, adding or increasing rapid-acting insulin, considering GLP-1 receptor agonists, SGLT-2 inhibitors, or DPP-4 inhibitors, or modifying dietary habits to include lower glycemic index foods and proper carbohydrate distribution, as suggested by recent guidelines 1.
• Postprandial hyperglycemia occurs when insulin secretion is delayed or insufficient relative to carbohydrate intake, or when insulin resistance prevents effective glucose uptake by tissues after meals, highlighting the importance of addressing both fasting and postprandial glucose for comprehensive diabetes management.
• The relationship between 2h post-load plasma glucose and mortality is linear, with high 2h post-load plasma glucose being a predictor for death, independent of FPG, as shown in the DECODE study 1.
• Goals should be individualized based on duration of diabetes, age/life expectancy, comorbid conditions, known CVD or advanced microvascular complications, hypoglycemia unawareness, and individual patient considerations, as recommended by recent guidelines 1.

From the FDA Drug Label

Liraglutide injection’s pharmacodynamic profile is consistent with its pharmacokinetic profile observed after single subcutaneous administration as liraglutide injection lowered fasting, premeal and postprandial glucose throughout the day Compared to placebo, the postprandial plasma glucose AUC 0-300min was 35% lower after liraglutide injection 1.2 mg and 38% lower after liraglutide injection 1. 8 mg.

The indications of increased 2-hour postprandial (2h pp) glucose in Diabetes Mellitus (DM) patients are not directly stated in the provided drug label. However, it can be inferred that increased 2h pp glucose is a condition that liraglutide aims to treat, as it lowers postprandial glucose throughout the day 2.

• Key points:
  • Liraglutide lowers postprandial glucose
  • Liraglutide delays gastric emptying, reducing the rate at which postprandial glucose appears in the circulation However, the label does not provide a direct answer to what the indications of increased 2h pp glucose are.

From the Research

Indications of Increased 2-Hour Postprandial Glucose in Diabetes Mellitus Patients

The following are indications of increased 2-hour postprandial (2h pp) glucose in Diabetes Mellitus (DM) patients:

• Elevated fasting plasma glucose concentrations are a marker for disturbances in glucose control which can lead to subsequent complications 3
• Postprandial glucose excursions are a fundamental risk factor for the development of cardiovascular disease, especially in older persons with Type 2 diabetes 3
• The postprandial (after breakfast) plasma glucose has a closer association to glycosylated hemoglobin than fasting plasma glucose 4
• Postprandial hyperglycemia contributes significantly to cardiovascular disease (CVD) risk 5, 6
• Increased 2-hour postprandial glucose levels are associated with an increased risk of microvascular and macrovascular complications 7
• The International Diabetes Federation (IDF) recommends that 2-hour post meal glucose levels are kept <7.8 mmol/L to reduce CVD risk 6

Mechanisms and Risk Factors

The mechanisms and risk factors associated with increased 2-hour postprandial glucose in DM patients include:

• Acute elevations of plasma glucose concentrations trigger an array of tissue responses that may contribute to the development of vascular complications 3
• Postprandial glucose fluctuations may exert an independent negative effect on the long-term outcome of diabetes 3
• The relationship between postprandial hyperglycemia and cardiovascular disease is well established, with postprandial glucose contributing to the overall glycemic load and CVD risk 5, 6
• The cellular mechanisms triggered in response to glucose excursions may explain the increased susceptibility to CVD 6

Therapeutic Targets and Strategies

The therapeutic targets and strategies for reducing increased 2-hour postprandial glucose in DM patients include:

• Targeting postprandial glucose to minimize CVD risk 5, 6
• Improving postprandial glycemic control with intensifying insulin therapy 7
• Using rapid-acting insulin analogs to control postprandial glucose excursions 7
• Continuous subcutaneous insulin infusion (CSII) as an option for intensifying therapy and improving postprandial control 7