Assessment of Postprandial Glucose Excursions Throughout the Day in Newly Diagnosed Type 2 Diabetes

Background: A growing body of evidence suggests that postprandial glucose (PPG) is independently linked to multiple complications and that testing of PPG should be added to hemoglobin A1c (HbA1c) and fasting glucose measurements in the evaluation of glycemic control of type 2 diabetes patients. An ongoing debate is questioning how to assess PPG. This observational study looks further into this question in a cohort of newly diagnosed type 2 diabetes patients. Subjects and Methods: PPG characteristics and intra-/intersubject variations post-breakfast, -lunch, and -dinner, obtained from continuous glucose monitoring (CGM), were retrospectively analyzed in 86 newly diagnosed non-insulin-treated type 2 diabetes patients. Results: In total, 462 recorded meals were analyzed. The area under the curve 1-4 h postmeal was significantly larger after breakfast compared with both lunch and dinner (P < 0.001). Time to peak was approximately 90 min and did not differ significantly between meals. However, the distribution of the blood glucose peaks was only normally distributed among breakfasts, and time to peak had a day-to-day correlation coefficient of 0.60, compared with a nonsignificant result for lunch and dinner. Breakfast PPG peaks were highly correlated to HbA1c (P < 0.05, r = 0.64) and had a day-to-day correlation coefficient of 0.86 compared with 0.44 for lunch and 0.74 for dinner. Conclusions: Self-monitoring of blood PPG should be evaluated with care. From our data, monitoring of PPG patterns in newly diagnosed type 2 diabetes patients should preferably be obtained following breakfast for a more consistent assessment, reducing day-to-day variations.