Contribution of Fasting and Postprandial Hyperglycemia to Hemoglobin A_(1c) in Insulin-Treated Japanese Diabetic Patients

摘要

The contribution of fasting and postprandial glucose to hemoglobin A_(1c) (HbA_(1c)) levels was evaluated in insulin-treated patients. In 57 insulin-treated, diabetic out-patients, fasting glucose (before breakfast (B-FG), lunch (L-FG) and dinner (D-FG)) and postprandial glucose (B-PPG, L-PPG and D-PPG) levels were determined by the patients themselves at home using glucose self-monitoring apparatus over the course of one week. The correlation between HbA_(1c) levels and self monitored blood glucose levels were calculated. In the conventionally treated group, there was a significant correlation between HbA_(1c) and fasting glucose (FG) levels only before lunch, but at 2 hr after (PPG) all meals. In the intensively treated group, a significant correlation between HbA_(1c) levels and FG levels was found before lunch and at 2 hr after breakfast and dinner. In all subjects, only FG levels before lunch correlated significantly with HbA_(1c) levels, although PPG levels were significantly correlated with HbA_(1c) at all points. The correlation was highest with PPG after breakfast and dinner. The sum of all FG, PPG and FG + PPG levels was significantly correlated with HbA_(1c) levels. Postprandial hyperglycemia after breakfast and dinner should be regarded as most important for improving HbA_(1c) levels in insulin treated diabetic patients.