Presentation on theme: "Glycemic Targets in Clinical Practice: Postprandial vs Preprandial and Fasting? The question is not whether to target postprandial, preprandial or fasting glycemia, but when, how, and to what goals. UKPDS Epidemiologic Data in Type 2 Diabetes No A1C Threshold 0% 10% 20% 30% 40% 50% 60% 70% 80% 567891011 Adjusted incidence per 1000 person- years Myocardial infarction Microvascular endpoints Updated mean A1C (%) Stratton IM, et al. To achieve a normal or near normal HbA 1c, both FPG and PPG levels must be normal or near normal. Patients With Type 2 Diabetes May Spend More Than 12 Hours per Day in the Postprandial State Adapted from Monnier L. Correlation between plasma glucose levels after OGTT and standard mixed meal Wolever TMS et al. As Patients Get Closer to A1C Goal, the Need to Successfully Manage PPG Significantly Increases Adapted from Monnier L, Lapinski H, Collette C.

Fasting Plasma Glucose Reflects Endogenous Glucose Production Dinneen S, Gerich J, Rizza R. Effect of Glyburide or NPH Insulin on Glycemia in Type 2 Diabetes Time of day From: Shapiro ET et al. The Future of Pumping Henry Anhalt, DO, CDE Director, Pediatric Endocrinology and Diabetes Saint Barnabas Medical Center Livingston, NJ. Excessive 24-Hour Glucose Fluctuations in Type 1 Patients with Mean A1C of 6.7% Levetan C, et al.
WTR 49% WTR 42% WTR 45% ATR 33% BTR 18% ATR 46% BTR 12% ATR 41% BTR 14% Brewer KW, Chase PH, Owen S, Garg SK.
Schematics of the Autosensor & Biographer Mask Hydrogel Pads Ionto Sensor Electrode Assembly Electronic Components Garg et al. Near Infrared Ray (NIR) Large desk-like apparatus Skin temperature and hydration Calibration is too cumbersome Patient intervention required Real Need!

Contributions of fasting and postprandial plasnma glucose increments to the overall diurnal hyper glycemia of Type 2 diabetic patients: variations with increasing levels of HBA(1c). Lowering FPG first will lower all PG values throughout the day and thus will also reduce PPG and may be sufficient. Limited availability of reliable continuous glucose monitoring Lack of alternate routes of insulin delivery.
The Average HbA1c is not the most complete expression of the degree of glycemia and the risk of complications may be more highly dependent on the excursions or influenced by counterregulatory hormonal responses to hypoglycemia.
Thus both FPG and PPG must be targets for therapy Thus both FPG and PPG must be targets for therapy Nevertheless, might there be situations in which it is preferable to treat one or the other first ???

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