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  • Glycemic Goals in Clinical Practice: Targeting Postprandial Hyperglycemia

    • Postprandial hyperglycemia is common in diabetics and it precedes fasting hyperglycemia.
    • Indian diet is rich in carbohydrates unlike Western diet. High dietary carbohydrate load is associated with increased risk of T2DM.
    • PPG is important because T2DM patients may be in the postprandial state for more than 12 hours in a day.
    • Increased PPG is associated with endothelial dysfunction and oxidative and nitrosative stress making it a strong predictor of CV events in diabetic patients (DECODE, Honolulu Heart study, DECODA).
    • Postmeal plasma glucose should be measured 1-2 hours after a meal.
    • For good glycemic control, both FPG and PPG should be normal or at least near normal levels.
    • If A1c <7.5%, initial therapy should address PPG, preferentially.
    • Reducing postprandial hyperglycemia → decreased CVD related morbidity and mortality.
    • α-glucosidase inhibitors like voglibose and voglibose-based combination therapy can effectively control postprandial hyperglycemia as they delay absorption of carbohydrates and also offer added advantages of being weight neutral & least risk of hypoglycemia.
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