DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20210460

Post prandial glucose can be a substitute for HbA1c in low resource setting: answering the diagnostic dilemma

Binay Kumar, Nidhi Prasad, Ravi Shekhar

Abstract


Achieving a strict glycaemic control is the key factor in diabetes management and associated complications. Although A1C is the best indicator of overall glycaemic control during the previous 2-3 months and remains the gold standard for assessing glycaemic control in patients with diabetes. But in low resource setting areas where HbA1c is a costlier affair, postprandial plasma glucose estimation can be a good alternative in estimating glycaemic control. By analyzing the results from many previous papers on glycaemic profiles, we conclude that contribution of postprandial plasma glucose was relatively high in patients with fairly good control of diabetes (HbA1c <7.5%) and decreased progressively with worsening diabetes (HbA1c >10.2%). Whereas the contribution of fasting plasma glucose showed a consistent contribution with increasing levels of HbA1c. So, we can understand that post-meal glycemia was a better predictor of good or satisfactory control of diabetes (HbA1c <7.5%) than was fasting glucose. Postprandial plasma glucose is the prominent contributor in patients with satisfactory to good control of diabetes, whereas the contribution of fasting plasma glucose increases with worsening diabetes. Hence, PPG is better in predicting overall glycaemic control in the absence of HbA1c.


Keywords


Post prandial glucose, Diabetes, Fasting plasma glucose, Complications, Glycosylated haemoglobin

Full Text:

PDF

References


World Health Organization. Global report on diabetes. 2016. ISBN 978 92 4 156525 7 (NLM classification: WK 810). Geneva: World Health Organization, 2016. Last accessed on 08 November, 2020.

International Diabetes Federation. IDF Diabetes Atlas, 9th edn. 2020. https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html. Last accessed 6th July, 2020.

Diabetes is more prevalent among the urban poor: A summary of the findings of the ICMR-INDIAB Study. Curr Med Issues. 2017;15:243-4. http://www.cmijounal.org/text.asp?2017/15/3/243/212384. Last accessed on 08 November, 2020.

World Health Organization. Projections of mortality and burden of disease to 2030. Burden of Disease Project 2006. http://www.who.int/entity/healthinfo/global_burden_disease/projections/en/. Last accessed on 08 November, 2020.

American Diabetes Association Economic costs of diabetes in the U.S. in 2007.Diabetes Care. 2008;31:596-615. Last accessed on 08 November, 2020.

United Nations World Population Prospects, the 2006 revision. Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. 2007. Last accessed on 08 November, 2020.

Zhang P, Zhang X, Brown J, Vistisen D, Sicree R, Shaw J’et al. Economic impact of diabetes. 4th ed. International Diabetes Federation. The Diabetes Atlas, Brussels. 2009.

World Health Organization. India: first to adapt the Global Monitoring Framework on Non-Communicable Diseases (NCDs). 2015. http://www.who.int/features/2015/ncd-india/en/. Last accessed on 25 March 2018.

Review of progress of on NCD to prevent early death resulting from it. https://www.who.int/ncds/governance/third-un-meeting/en/. Last accessed on 28 June, 2020.

Haddadinezhad S, Ghazaleh N. Relation of fasting and postprandial and plasma glucose with hemoglobinA1c in diabetics. Int J Diabetes Dev Ctries. 2010;30(1):8-10.

Szymczak-Pajor I. Analysis of Association between Vitamin D Deficiency and Insulin Resistance. Nutrients. 2019;11(4):794.

Cryer PE. Glucose counterregulation: Prevention and correction of hypoglycemia in humans. Am J Physiol. 1993;264:E149-155.

Pant V, Gautam K, Pradhan S. Postprandial Blood Glucose can be less than Fasting Blood Glucose and this is not a Laboratory Error J Nepal Med Assoc. 2019;57(215):67-8.

Gebhard B, Holst JJ, Biegelmayer C, Miholic J. Post prandial GLP-1, norepinephrine and reactive hypoglycaemia in dumping syndrome. Dig Dis Sci. 2001;46(9):1915-923.

American Diabetes Association Standards of medical care in diabetes. Diabetes Care. 2014;37:S14-80.

Centers for Disease Control and Prevention (CDC). Awareness of prediabetes--United States, 2005-2010, MMWR: Morbidity and Mortality Weekly Report. 2013;62:209-12.

Ho-Pham LT, Nguyen UDT, Tran TX, Nguyen TV. Discordance in the diagnosis of diabetes: comparison between HbA1c and fasting plasma glucose. PLoS One. 2017;12:e0182192.

Lo CC, Lara J, Cheng TC. Skin deep: enhanced variable may help explain racial disparities in type 2 diabetes and prediabetes. Diabetes Therapy. 2017;8(4):837-50.

The DECODE Study Group, on behalf of the European Diabetes Epidemiology Group. Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-h diagnostic criteria. Arch Intern Med. 2001; 161:397-404.

Khaw KT, Wareham N, Bingham S, Luben R, Welch A, Day N. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med. 2004;141:413-420.

Cavalot F, Petrelli A, Traversa M, Bonomo K, Fiora E, Conti M et al. Postprandial Blood Glucose Is a Stronger Predictor of Cardiovascular Events Than Fasting Blood Glucose in Type 2 Diabetes Mellitus, Particularly in Women: Lessons from the San Luigi Gonzaga Diabetes Study. The Journal of Clinical Endocrinology & Metabolism. 2006;91(3):813-19.

DECODE Study Group, the European Diabetes Epidemiology Group. Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med. 2001;161:397-404.

International Diabetes Federation 2011; Guideline for management of postmeal glucose in diabetes. www.idf.org. Last accessed 17th August, 2015.

O’Keefe JH, Gheewala NM, O’Keefe J. Dietary Strategies for Improving Post-Prandial Glucose, Lipids, Inflammation, and Cardiovascular Health. Journal of the American College of Cardiology. 2008;51(3):249-55.

Why Checking Postprandial Glucose Is Important. Available at: https://www.everydayhealth.com/hs/type-2-diabetes-management/postprandial-glucose/. Accessed on 6th July, 2020.

Monnier L. Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients: variations with increasing levels of HbA(1c). Diab Care. 2003;26(3):881-85.

International Diabetes Federation 2011; Guideline for management of postmeal glucose in diabetes. www.idf.org. Last accessed 17th August, 2015.

Punthakee Z, Goldenberg R. Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome. Can J Diabetes. 2018;42:S10-S15.

Rybicka M, Krysiak R, Okopień B. The dawn phenomenon and the Somogyi effect - two phenomena of morning hyperglycaemia. Endokrynol Pol. 2011;62(3):276-84.

Gale EA, Kurtz AB, Tattersall RB. In search of the Somogyi effect. Lancet. 1980;2(8189):279-82.

UK Prospective Diabetes Study (UKPDS) Group Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837-53.

The Diabetes Control and Complications Trial Research Group The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the Diabetes Control and Complications Trial. Diabetes. 1995;44:968-83.

Swetha NK. Comparison of fasting blood glucose & post prandial blood glucose with HbA1c in assessing the glycemic control. International J of Healthcare and Biomedical Research. 2014;2(3):134-39.

Sheppard P, Bending JJ, Huber JW. Pre- and post-prandial capillary glucose self-monitoring achieves better glycaemic control than pre-prandial only monitoring: A study in insulin treated diabetic patients. Practical Diabetes Int. 2005;22(1):15-22.

Weykamp C, Garry John W, Mosca A. A review of the challenge in measuring hemoglobin A1c. Journal of diabetes Sci Technol. 2009;3(3):439-45.

Pasupathi P, Manivannan P M, Uma M, Deepa M. Glycated haemoglobin (HbA1c) as a stable indicator of type 2 diabetes Int J Pharm. Biomed Res. 2010;1(2):53-6.

Ken S. The correlation of hemoglobin A1c to blood glucose. J Diabetes Sci Technol. 2009;3(3):429-38.

Son JI, Rhee SY, Woo JT. Hemoglobin A1c may be an inadequate diagnostic tool for diabetes mellitus in anemic subjects. Diabetes Metab J. 2013;37:343-8.

Attard SM, Herring AH, Wang H. Implications of iron deficiency/anemia on the classification of diabetes using HbA1c. Nutr Diabetes. 2015;5:e166.

Mahato R, Gyawali P, Raut PP, Regmi P, Singh KP, Raj Pandeya DP, et al. Association between glycaemic control and serum lipid profile in type 2 diabetic patients: Glycated haemoglobin as a dual biomarker. Biomedical Researchm. 2011;22(3):375-80.

UK Prospective Diabetes Study (UKPDS) Group Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) Lancet. 1998;352:837-53.

The Diabetes Control and Complications Trial Research Group The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the Diabetes Control and Complications Trial. Diabetes. 1995;44:968-83.

Swetha NK. Comparison of fasting blood glucose & post prandial blood glucose with HbA1c in assessing the glycemic control. International J of Healthcare and Biomedical Research. 2014;2(3):134-39.

Ketema EB, Kibret KT. Correlation of fasting and postprandial plasma glucose with HbA1c in assessing glycemic control; systematic review and meta-analysis. Arch Public Health. 2015;73:43.

M Rosediani , AK Azidah, M Mafauzy. Correlation Between Fasting Plasma Glucose, Post Prandial Glucose and Glycated Haemoglobin and Fructosamine . Med J Malaysia. 2006;61(1):67-71.

David A. Zhang, Laurence Katznelson, and Ming Li, Journal of Diabetes Science and Technology. 2012;6(2):289-93.

Woerle HJ, Pimenta WP, Meyer CP, Gosmanov NP, Szoke E, Szombathy T et al. Diagnostic and Therapeutic Implications of Relationships Between Fasting, 2-Hour Postchallenge Plasma Glucose and Hemoglobin A1c Values. Arch Intern Med. 2004;164:1627-32.

Bonora E, Corrao G, Bagnardi V, Ceriello A, Comaschi M, Montanari P et al. Prevalence and correlates of postprandial hyperglycaemia in a large sample of patients with type 2 diabetes mellitus. Diabetologia. 2006;49:846-54.

Woerle HJ, Pimenta WP, Meyer C, Gosmanov NR, Szoke E, Szombathy T et al. Diagnostic and therapeutic implications of relationships between fasting, 2-hour postchallenge plasma glucose and hemoglobin A1C values. Arch Intern Med. 2004;164:1627-32.