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Diabetes :: New IDF guidelines raise importance of post-meal glucose control

The International Diabetes Federation (IDF) has published new guidelines on the contribution and impact of post-meal glucose in diabetes disease management at the 43rd Annual Meeting of the European Association for the Study of Diabetes (EASD) on September_19, 2007. The IDF recognises the growing evidence that post-meal glucose is a key contributor to overall glycaemic control – particularly with respect to HbA1C levels, and that reducing post-meal glucose has a significant impact on the risk of developing diabetic complications.

The new guidelines include a specific reference to acarbose (Glucobay®*) as a pharmacological agent with a substantial body of evidence proving that it lowers post-meal glucose and thereby effectively reduces the risks associated with high post-meal glucose levels.

Acarbose lowers post-meal blood glucose and HbA1C in an effective and well tolerated manner, and reduces the risk of cardiovascular complications in patients with type 2 diabetes.1 The benefits of acarbose are evident in individuals at a high risk of developing diabetes (pre-diabetes), in whom it reduces risks of diabetes and serious cardiovascular events.2, 3

Professor Pierre Lefèbvre, immediate past president of the IDF, highlighted that interest in post-meal glucose started 30 years ago with Bayer’s discovery that acarbose lowers post-meal hyperglycaemia. Acarbose is one of a number of pharmacological agents recommended in the guidelines to lower post-meal glucose.

The recommendation for acarbose is supported by the results of the Study to Prevent Non-Insulin Dependent Diabetes Mellitus (STOP-NIDDM) and the Metaanalysis of Risk Improvement under Acarbose (MeRIA).2-5

Professor Antonio Ceriello, chair of the Guideline Development Steering Committee, presented the key recommendations from the guidelines:

Post-meal hyperglycaemia is harmful and should be addressed.
Treatment strategies to lower post-meal plasma glucose in people with post-meal hyperglycaemia should be implemented.
Two-hour post-meal plasma glucose should not exceed 7.8 mmol/l (140 mg/dl) as long as hypoglycaemia is avoided.
A variety of both non-pharmacologic and pharmacologic therapies should be considered to target post-meal plasma glucose.

The diabetic population is increasing by 7 million each year, with almost 4 million deaths, the majority of which arise from macrovascular complications. There is a real need to raise awareness and to integrate the recommendations of the IDF into clinical practice. The steering committee acknowledged the challenges of measuring post-meal glucose in the clinic, but recommended innovative approaches such as the use of risk prediction tools to identify high-risk individuals.

* in some countries: Glucor®, Prandase®, Precose®

References
1. Van de Laar F, et al. Diabetes Care 2005;28:154–75.
2. Chiasson JL, et al. Lancet 2002;359:2072–7.
3. Chiasson JL, et al. JAMA 2003;290:486–94.
4. Hanefeld M, et al. Stroke 2004;35:1073–78.
5. Hanefeld M, et al. Eur Heart J 2004;25:10–16.

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Diabetes :: New IDF guidelines raise importance of post-meal glucose control
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