Diabetologie und Stoffwechsel 2007; 2 - A1
DOI: 10.1055/s-2007-984747

High postprandial blood glucose is associated with prevalent cardiovascular disease independent of HbA1c in well controlled type 2 diabetic patients

J Brix 1, A Feder 1, K Krzyzanowska 1, F Mittermayer 1, G Schernthaner 1
  • 1Department of Internal Medicine I, Rudolfstiftung Hospital, Vienna, Austria

Background/Aims:

HbA1c is a well known predictor for diabetic complications. Postprandial blood glucose levels were also discussed to be responsible for the occurrence of cardiovascular events in patients with type 2 diabetes (T2DM). In the present study weinvestigated if high postprandial blood glucose levels are associated with the prevalence of cardiovascular disease (CHD, PAD, previous MI, previous stroke) independent of HbA1c levels.

Methods:

We included 431 patients with T2DM (mean age 61 yrs., 196 female) in a cross-sectional study. Blood glucose levels (2 hours postprandial) and HbA1c were measured by standard procedures. Patients were allocated to six different groups according to tertiles of HbA1c. Group 1 (n=51): HbA1c <6.9%, glucose <140 mg/dl; Group 2 (n=90): HbA1c <6.9%, glucose >140 mg/dl; Group 3 (n=53): HbA1c =6.9% and <8.2%, glucose <140 mg/dl; Group 4 (n=85): HbA1c =6.9% and <8.2%, glucose >140 mg/dl; Group 5 (n=28): HbA1c =8.2%, glucose <140 mg/dl and Group 6 (n=124): HbA1c =8.2% and glucose >140 mg/dl. In each group the prevalence of cardiovascular disease was assessed. Furthermore total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides and creatinine were measured.

Results:

Cardiovascular disease was reported in 5.9% of the patients in group 1, 70.0% in group 2 (P<0.001 vs. group 1), 28.3% in group 3 (P=0.003), 25.9% in group 4 (P=0.004), 25.0% in group 5 (P=0.015) and 29.0% in group 6 (P<0.001). According to a logistic regression analysis an increase of postprandial glucose by 1 mg/dl was associated with an odds ratio of 1.007 (95%CI: 1.001 – 1.012; P=0.014) for the prevalence of cardiovascular disease after adjustment for age, sex, HbA1c, antidiabetic treatment, systolic blood pressure, triglycerides and LDL-cholesterol.

Conclusions:

Postprandial blood glucose levels >140 mg/dl are associated with a high prevalence of cardiovascular disease independent of HbA1c, suggesting that the postprandial glucose could play a more important role for cardiovascular disease than HbA1c in well controlled type 2 diabetic patients.