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New research is showing that what matters after dinner is not dessert. In a study published in the September 2000 issue of Diabetes Care, a team of researchers say their findings show that good postprandial (after-meal) glucose levels are key to overall control and lowering HbA1cs.
The study placed 135 type 2 test subjects on one of three combination therapies, all of them using the sulfonylurea glyburide as one of their components. Supplemental doses of insulin lispro, metformin, or bedtime NPH were given to roughly one-third of the subjects each. The three regimens were geared toward reducing after-meal, pre-meal and fasting BG levels, respectively.
Among the 114 test subjects who completed the study, there were no significant differences in instances of hypoglycemia, weight gain or overall level of satisfaction with the course of treatment. Glucose readings, however, varied drastically between the three groups. Although no significant statistical difference in initial HbA1c reading was recorded between the three groups at the beginning of the study, subsequent readings one and three months into the study showed substantially lower levels in the group combining glyburide with insulin lispro. At the end of the study, the average HbA1c level for the lispro group was 7.7%, as opposed to 8.5% in the NPH group and 8.3% in the metformin group. The lispro group showed higher fasting glucose levels than the metformin and NPH groups, but also had an average two-hour after-meal BG between 20 and 30 mg/dl lower than either of the other groups.
The researchers speak enthusiastically of adding any second antihyperglycemic agent to the treatment regimen. They conclude, however, that the overwhelming impact that tight after-meal blood glucose levels have on overall BG control make it a particularly useful treatment goal.
Good after-meal control, the study argues, can improve a host of long-term outcomes, particularly in reducing the risks of cardiovascular disease and all-cause mortality.
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