Postprandial Hyperglycemia and Diabetes Complications

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Postprandial Hyperglycemia and Diabetes Complications
Received for publication July 12, 2004 and accepted in revised form September 13, 2004
Antonio Ceriello
Diabetes

© 2005 by the American Diabetes Association, Inc.

Perspectives in Diabetes

From the Department of Pathology and Medicine, Experimental and Clinical, University of Udine, Udine, Italy

ABSTRACT

Increasing evidence suggests that the postprandial state is a contributing factor to the development of atherosclerosis. In diabetes, the postprandial phase is characterized by a rapid and large increase in blood glucose levels, and the possibility that the postprandial "hyperglycemic spikes" may be relevant to the onset of cardiovascular complications has recently received much attention. Epidemiological studies and preliminary intervention studies have shown that postprandial hyperglycemia is a direct and independent risk factor for cardiovascular disease (CVD). Most of the cardiovascular risk factors are modified in the postprandial phase in diabetic subjects and directly affected by an acute increase of glycemia. The mechanisms through which acute hyperglycemia exerts its effects may be identified in the production of free radicals. This alarmingly suggestive body of evidence for a harmful effect of postprandial hyperglycemia on diabetes complications has been sufficient to influence guidelines from key professional scientific societies. Correcting the postprandial hyperglycemia may form part of the strategy for the prevention and management of CVDs in diabetes.

Diabetes is characterized by a high incidence of cardiovascular disease (CVD) (1), and poor control of hyperglycemia appears to play a significant role in the development of CVD in diabetes (2). Recently, there has been increasing evidence that the postprandial state is an important contributing factor to the development of atherosclerosis (3). In diabetes, the postprandial phase is characterized by a rapid and large increase in blood glucose levels, and the possibility that these postprandial "hyperglycemic spikes" may be relevant to the pathophysiology of late diabetes complications is recently receiving much attention.

In this article, epidemiological data and preliminary results of intervention studies indicating that postprandial hyperglycemia represents an increased risk for CVD are surveyed and the proposed mechanisms involved in this effect are summarized.

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