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Importance of Fasting Hyperglycemia Varies, Depending on HbA1c

Posted: Wednesday, October 25, 2006

Treating fasting blood sugars when the A1c is elevated, has a greater impact on the resulting A1c.

Fasting hyperglycemia plaA group of investigators led by Dr Rajesh Peter of the Llandough Hospital in Penarth, UK, evaluated the relationship between HbA1c and other markers of glycemic control during a standardized meal tolerance test (MTT) in patients with newly diagnosed, untreated type 2 diabetes. A total of 262 patients received the MTT in the morning following a 10-hour overnight fast. Excess hyperglycemia was defined as the area under the curve (AUC0-4h) above the upper limit of fasting normoglycemia, according to the World Health Organization (WHO; 6.0mmol/L) or the American Diabetes Association (ADA; 5.5mmol/L). Fasting hyperglycemia was defined as the difference between the upper limits of fasting normoglycemia and the postprandial glucose excursion. Patients were classified into 3 groups, based on HbA1c (7.0% or less, 7.1-9.0%, or more than 9.0%).

The investigators found that HbA1c correlated more strongly with fasting plasma glucose (r=0.85; p<0.001) than with postprandial glucose exposure (r=0.539; p=0.003). For groups 1, 2, and 3, the contribution of fasting hyperglycemia to excess hyperglycemia was 50.4%, 54.3%, and 69.8%, respectively, using the WHO criteria, and 57.8%, 58.8%, and 71.4%, respectively, using the ADA criteria.

The investigators concluded that the contribution of fasting hyperglycemia to excess hyperglycemia was greater in patients with increased HbA1c, indicating that treatment should vary depending on the HbA1c at baseline.

Source: Diabetes In Control: Diabetic Medicine 2006;23:990-5