Open AccessRelationship of glycated hemoglobin, and fasting and postprandial hyperglycemia in type 2 diabetes mellitus patients in Malaysia
Author(s) -
Lim Lee Ling,
Brnabic Alan JM,
Chan Siew Pheng,
Ibrahim Luqman,
Paramasivam Sharmila Sunita,
Ratnasingam Jeyakantha,
Vethakkan Shireene Ratna,
Tan Alexander Tong Boon
Publication year - 2017
Publication title -
journal of diabetes investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.089
H-Index - 50
eISSN - 2040-1124
pISSN - 2040-1116
DOI - 10.1111/jdi.12596
Subject(s) - medicine , postprandial , glycated hemoglobin , diabetes mellitus , hypoglycemia , area under the curve , endocrinology , hemoglobin , type 2 diabetes , glycemic , cohort , type 2 diabetes mellitus , gastroenterology
Aims/Introduction Studies on the relative contributions of fasting and postprandial hyperglycemia ( FH and PPH ) to glycated hemoglobin (HbA 1c ) in patients with type 2 diabetes have yielded inconsistent results. We aimed to assess the relationship by using continuous glucose monitoring in a multi‐ethnic cohort. Materials and Methods A total of 100 adults with type 2 diabetes were assessed with 6‐day continuous glucose monitoring and HbA 1c . Area under the curve ( AUC ) ≥5.6 mmol/L was defined as AUC TOTAL . AUC equal to or greater than each preprandial glucose for 4‐h duration was defined as AUC PPH . The total PPH ( AUC TPPH ) was the sum of the various AUC PPH . The postprandial contribution to overall hyperglycemia was calculated as ( AUC TPPH / AUC TOTAL ) × 100%. Results The present study comprised of Malay, Indian, and Chinese type 2 diabetes patients at 34, 34 and 28% respectively. Overall, the mean PPH significantly decreased as HbA 1c advanced (mixed model repeated measures adjusted, beta‐estimate = −3.0, P = 0.009). Age ( P = 0.010) and hypoglycemia ( P = 0.006) predicted the contribution difference. In oral antidiabetic drug‐treated patients ( n = 58), FH contribution increased from 54% (HbA 1c 6–6.9%) to 67% (HbA 1c ≥10%). FH predominance was significant in poorly‐controlled groups ( P = 0.028 at HbA 1c 9–9.9%; P = 0.015 at HbA 1c ≥10%). Among insulin users ( n = 42), FH predominated when HbA 1c was ≥10% before adjustment for hypoglycemia ( P = 0.047), whereas PPH was numerically greater when HbA 1c was <8%. Conclusions FH and PPH contributions were equal in well‐controlled Malaysian type 2 diabetes patients in real‐world practice. FH predominated when HbA 1c was ≥9 and ≥10% in oral antidiabetic drug‐ and insulin‐treated patients, respectively. A unique observation was the greater PPH contribution when HbA 1c was <8% despite the use of basal and mealtime insulin in this multi‐ethnic cohort, which required further validation.