Targets and tactics: the relative importance of HbA, fasting and postprandial plasma glucose levels to glycaemic control in type 2 diabetes.

摘要

BACKGROUND: The incidence of type 2 diabetes is reaching pandemic proportions, impacting patients and healthcare systems across the globe. Evidence suggests that a majority of patients are not achieving recommended blood glucose targets resulting in an increased risk of micro- and macro-vascular complications. AIM: To review literature on the significance of glycosylated haemoglobin (HbA(1c)), fasting plasma glucose (FPG) and postprandial plasma glucose (PPG), their inter-relationships and relative importance in the treatment of diabetes, and to provide practical guidance on effective monitoring of patients. METHODS: Clinical guidelines on diabetes management and clinical and preclinical studies of glycaemic control identified through a publications database search were reviewed. RESULTS: Glycaemic control remains fundamental to the successful management of diabetes. HbA(1c) is the gold standard measure of glycaemic control but recent evidence suggests that postmeal hyperglycaemia also plays an important role in the aetiology of diabetes-associated complications and control of PPG levels is vital to the achievement of recommended HbA(1c) targets. CONCLUSIONS: The call for action on type 2 diabetes has never been more compelling; with a clear focus on strategies for glycaemic control, the impact of the diabetes pandemic can be limited.