Anil K Mandal
Keynote: J Diabetes Metab
Fasting blood glucose (FBG) >126 mg/dL(7 mmol/L) and/or glycosylated hemoglobin(HbA1c) >6.5% have traditionally been used as amarker for the diagnosis of diabetes and initiationof a treatment plan. Despite the use of thesediagnostic markers and a plethora of oralhypoglycemic agents, diabetic complicationsnamely, cardiovascular disorders, renal failure and dialysis, and amputations, are on the rise. Therefore a reasonable concern is that either thedefinition of diabetes or the prevalent therapywith oral hypoglycemic agents, or both, are faulty.Abundant literature is available regarding theimportance of using 2-hour postprandial glucose(2hPPG) in glycemic control for the prevention ofdiabetic complications. A robust association hasbeen shown between 1-h or 2-h postprandialhyperglycemia (>200 mg/dL; 11.1 mmol/L)and cardiovascular disorders and mortality.Notwithstanding the availability of such important information, 2hPPG control is still under-usedin clinical practice of diabetes care. Worse than that, popularity of use of FBG and/or HbA1c as aguide for diabetes care has permitted an incorrectdiagnosis of Type 2 diabetes in numeroushypertensive patients treated with a thiazide diuretic. Control of postprandial hyperglycemia: How important is itin the prevention of diabetic complicationsand having elevated glucose levels followed bymistreatment with oral hypoglycemic agents. Theresult is subsequent development of overt diabetesin many individuals, some of them are riddledwith numerous complications such as foot ulcer,gangrene, kidney failure or heart disease. Thisarticle is dedicated to redirecting the attentionfrom using FBG and or HbA1c to 2hPPG as afundamental tool for evaluation of diabetes and tofocus on therapy encompassing 2hPPG. Evidencehas emerged from basic as well as clinicalresearch claiming the importance of control ofpostprandial hyperglycemia in the prevention ofdiabetic complications. Prevention of diabeticcomplications is attainable by control ofpostprandial hyperglycemia with the prescription ofa combination of Glargine insulin twice daily (12hours apart) and treatment of glycemic excursionswith fast-acting insulin.
Anil K Mandal is a native of India and a naturalized citizen of the United States. He is board certified in Internal Medicine and Nephrology (kidney disease and hypertension). He is an author of a dozen books and more than 100 published articles on research in diabetes and kidney disease. He is a two-time Fulbright Scholar and a visiting professor in 23 countries that invited him to lecture on diabetes, high blood pressure, and kidney diseases.
