Type 2 diabetes: postprandial hyperglycemia and increased cardiovascular risk

Ajikumar V Aryangat, John E Gerich, Ajikumar V Aryangat, John E Gerich

Abstract

Hyperglycemia is a major risk factor for both the microvascular and macrovascular complications in patients with type 2 diabetes. This review summarizes the cardiovascular results of large outcomes trials in diabetes and presents new evidence on the role of hyperglycemia, with particular emphasis on postprandial hyperglycemia, in adverse cardiovascular outcomes in patients with type 2 diabetes. Treatment options, including the new dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 mimetics that primarily target postprandial hyperglycemia, are also discussed. Hyperglycemia increases cardiovascular mortality, and reducing hyperglycemia lowers cardiovascular risk parameters. Control of both fasting and postprandial hyperglycemia is necessary to achieve optimal glycated hemoglobin control. Therefore, anti-hyperglycemic agents that preferentially target postprandial hyperglycemia, along with those that preferentially target fasting hyperglycemia, are strongly suggested to optimize individual diabetes treatment strategies and reduce complications.

Keywords: cardiovascular risk; diabetes mellitus; drugs; postprandial hyperglycemia.

Figures

Figure 1
Figure 1
Significant relative risk reduction in microvascular disease and any diabetes end point continued during 10 years of post-trial follow-up. Significant emergent risk reductions in myocardial infarction and all-cause mortality were observed only with extended follow-up., Adapted from The Lancet, 352, UK Prospective Diabetes Study (UKPDS) Group, Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33), 837–853. Copyright © (1998), with permission from Elsevier.
Figure 2
Figure 2
Mechanisms by which hyperglycemia induces mitochondrial overproduction of superoxide and activates 4 major pathways of hyperglycemic damage., Copyright © 2005 American Diabetes Association from Diabetes. 2005;54:1615–1625.27 Adapted with permission from the American Diabetes Association.

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