Targeting postprandial glucose control using ultra-rapid insulins: is faster better?
Abstract
Type 2 diabetes (T2D) is characterised by defects in both fasting and postprandial glucose (PPG) control. Many Asians including Chinese people with T2D have isolated high PPG at diagnosis without concomitant elevation in fasting plasma glucose (FPG). This might be due to differences in genetic architecture, low insulin secretion, and high carbohydrate diet in East Asians. Excursions in PPG contribute significantly to glycemic variability (GV), which is associated with increased risk of cardiovascular-renal-cancer events [1]. Asians with T2D are less likely to achieve target hemoglobin A1c (HbA1c) of < 7% using basal insulin alone than non-Asians. In a meta-analysis of randomised controlled trials in patients started on insulin glargine 100 U/mL, 40% Asian vs. 47% non-Asian patients achieved target HbA1c of < 7% despite achieving optimal FPG [2]. In a small study of insulin-naïve Chinese patients with T2D initiated on second-generation basal insulin analogues, elevated PPG contributed significantly to suboptimal HbA1c and time-above-range and GV on continuous glucose monitoring (CGM), despite optimisation of FPG [3].
- Publication:
-
Science Bulletin
- Pub Date:
- December 2022
- DOI:
- 10.1016/j.scib.2022.11.025
- Bibcode:
- 2022SciBu..67.2392C