Manipulation of Post-Prandial Hyperglycaemia in Type 2 Diabetes: An Update for Practitioners.

This review paper explores post-prandial glycemia in type 2 diabetes. Post-prandial glycemia is defined as the period of blood glucose excursion from immediately after the ingestion of food or drink to 4 to 6 hours after the end of the meal. Post-prandial hyperglycemia is an independent risk factor for cardiovascular disease with glucose "excursions" being more strongly associated with markers of oxidative stress than the fasting or pre-prandial glucose level. High blood glucose is a major promoter of enhanced free radical production and is associated with the onset and progression of type 2 diabetes. Oxidative stress impairs insulin action creating a vicious cycle where repeated post-prandial glucose spikes are key drivers in the pathogenesis of the vascular complications of type 2 diabetes, both microvascular and macrovascular. Some authors suggest post-prandial hyperglycemia is the major cause of death in type 2 diabetes. Proper management of post-prandial hyperglycemia could yield up to a 35% cut in overall cardiovascular events, and a 64% cut in myocardial infarction. The benefits of managing post-prandial hyperglycemia are similar in magnitude to those seen in type 2 diabetes patients receiving secondary prevention with statins - prevention which today is regarded as fundamental by all practitioners. Given all the evidence surrounding the impact of post-prandial glycemia on overall outcome, it is imperative that any considered strategy for the management of type 2 diabetes should include optimum dietary, pharma, and lifestyle interventions that address glucose excursion. Achieving a low post-prandial glucose response is key to prevention and progression of type 2 diabetes and cardiometabolic diseases. Further, such therapeutic interventions should be sustainable and must benefit patients in the short and long term with the minimum of intrusion and side effects. This paper reviews the current literature around dietary manipulation of post-prandial hyperglycemia, including novel approaches. A great deal of further work is required to optimize and standardize the dietary management of post-prandial glycemia in type 2 diabetes, including consideration of novel approaches that show great promise.

Informations de copyright

© 2024 Shibib et al.

Déclaration de conflit d'intérêts

ADM has received research funding from the MRC, NIHR, Jon Moulton Charitable Foundation, Fractyl, Gila, Randox and Novo Nordisk. ADM is a shareholder in the Beyond BMI clinic, which provides clinical obesity care. ADM reports personal fees from Lilly, personal fees from Astra Zeneca, personal fees from Boehringer Ingelheim, personal fees from Currax, personal fees from Algorithm, during the conduct of the study. NG reports personal fees from Heartland Food Products Group, personal fees from Eli Lilly, personal fees from Boehringer Ingelheim, grants from Oviva, during the conduct of the study. Dr Mo Al-Qaisi reports being director and sole shareholder of Ziro Foods Ltd, outside the submitted work. The authors report no other conflicts of interest in this work.