Can postprandial blood glucose excursion be predicted in type 2 diabetes? - PubMed (original) (raw)
Can postprandial blood glucose excursion be predicted in type 2 diabetes?
Sylvia Franc et al. Diabetes Care. 2010 Sep.
Abstract
Objective: We investigated the relationship between carbohydrate intake and postprandial blood glucose (BG) levels to determine the most influential meal for type 2 diabetic subjects treated with basal insulin and needing prandial insulin.
Research design and methods: Three-day BG profiles for 37 type 2 diabetic subjects, with A1C levels of 7.7%, treated with sulfonylurea and metformin, and well titrated on insulin glargine, were analyzed using a continuous glucose monitoring system. Food intake from 680 meals was recorded and quantified during continuous glucose monitoring.
Results: The median BG excursion (DeltaBG) was higher at breakfast than at lunch or dinner (111 [81; 160] vs. 69.5 [41.5; 106] and 82.5 mg/dl [53; 119] mg/dl, P < 0.0001). There was a weak overall correlation between DeltaBG and carbohydrate intake. Correlation improved when mealtime was taken into account. Simple relationships were established: DeltaBG (mg/dl) = 65 x carbohydrate/body weight + 73 for breakfast (R(2) = 0.20, P < 0.0001); the slope was reduced by half at lunch and by one-third at dinner. Twelve relevant variables likely to affect DeltaBG were integrated into a polynomial equation. This model accounted for 49% of DeltaBG variability. Two groups of patients were identified: responders, in whom DeltaBG was well correlated with carbohydrate intake (R(2) >or= 0.30, n = 8), and nonresponders (R(2) < 0.30, n = 29). Responders exhibited a greater insulinopenic profile than nonresponders.
Conclusions: The carbohydrate intake in responders clearly drives DeltaBG, whereas, in nonresponders, other factors predominate. This sort of characterization should be used to guide therapeutic choices toward more targeted care with improved type 2 diabetes management.
Figures
Figure 1
The 4-h PPBG profiles: the start times of all meals (breakfasts, lunches, and dinners) were superimposed in the analysis (time 0). PPBG analysis was then performed over a period of 4 h from time 0. Median ΔBG was significantly higher at breakfast than at lunch and dinner (111 [81; 160] vs. 69.5 [41.5; 106] and 82.5 [53; 119] mg/dl, P < 0.0001). Median peak BG excursion was reached 110 min (80; 165) after the start of meals, but differed according to meal type (95 [75; 120] min at breakfast vs. 120 [80; 180] min at lunch and 125 [95; 190] min at dinner, P < 0.0001).
Figure 2
Linear relationship between CHO intake based on weight and ΔBG for a responder (A) (good correlation between CHO intake/weight and ΔBG) and for a nonresponder (B) (no correlation between CHO intake/weight and ΔBG).
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