Targeting plasma glucose: preprandial versus postprandial

Over the past decade, a majorinterest in postprandial glucose(PPG) has emerged, in part because of a plethora of new medica-tions that specifically target PPG. These include insulin analogs (lispro and aspart), insulin secretagogues (repaglin-ide and nateglinide), alpha-glucosidase inhibitors (miglitol and acarbose), and injectable amylin analogs and glucagon-like peptide receptor agonists. Targeting plasma glucose has been an accepted practice. For example, in the Diabetes Control and Complication Trial (DCCT) involving type 1 diabetic patients, pattern analysis of pre-meal glucose values was targeted first. In the U.K. Prospective Diabetes Study (UKPDS), the fasting blood glucose (FBG) was targeted, and medications were titrated based on FBG.1 Consider-ing there are potentially seven points within a 24-hour glucose profile (pre-meals, post-meals, and at bedtime), the question of which glucose value(s) to target first and which will have the most impact on hemoglobin A1c (A1C), is an important one for both patients and busy practitioners