Type 2 diabetes managed by diet and lifestyle: HbA1c can identify significant post-prandial hyperglycaemia

Practical Diabetes, 04/19/2012

McGeoch S et al. – Even volunteers with reasonably well–controlled, diet–managed type 2 diabetes spent a large proportion (9/24 hours) of the day with glucose concentrations in excess of 8mmol/L, suggesting that implementation of the International Diabetes Federation (IDF) guidelines presents a challenge in normal clinical practice. HbA1c was a good indicator of post–prandial hyperglycaemia.

Methods

  • Twenty-nine volunteers with diet-controlled type 2 diabetes were recruited (mean HbA1c 50mmol/mol [6.7%], SD 6.5 [0.6]); mean age 62 years [SD 5.8]; mean BMI 31.9kg/m2 [SD 5.3]), and underwent a three-day period of continuous glucose monitoring (CGMS) at home.

Results

  • Compared with volunteers with an HbA1c >48mmol/mol (6.5%), those with an HbA1c ≤48mmol/mol (6.5%) - mean HbA1c 54 (7.1%) vs 44.9mmol/mol (6.3%), p<0.0001 - had lower mean 24-hour glucose levels (8.4 vs 7.2mmol/L, p=0.02), reduced fasting glucose concentrations (8.0 vs 6.6mmol/L, p=0.01), and spent less time with glucose concentrations >8mmol/L (703.1 vs 338.5 min, p=0.01).
  • HbA1c showed reasonable correlation with time spent with glucose >8mmol/L (r2=0.48, p<0.0001).

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