Background/objective

There is substantial interest in dietary approaches to reducing postprandial glucose (PPG) responses, but the quantitative contribution of PPG to longer-term glycemic control (reflected in glycated hemoglobin, HbA_1c) in the general population is not known. This study quantified the associations of preprandial glucose exposure, PPG exposure, and glycemic variability with HbA_1c and estimated the explained variance in HbA_1c in individuals with and without type 2 diabetes (T2D).

Subjects/methods

Participants in the A1c-Derived Average Glucose (ADAG) study without T2D (n = 77) or with non-insulin-treated T2D and HbA_1c<6.5% (T2D_{HbA1c < 6.5%}, n = 63) or HbA_1c ≥ 6.5% (T2D_{HbA1c ≥ 6.5%}, n = 34) were included in this analysis. Indices of preprandial glucose, PPG, and glycemic variability were calculated from continuous glucose monitoring during four periods over 12 weeks prior to HbA_1c measurement. In linear regression models, we estimated the associations of the glycemic exposures with HbA_1c and calculated the proportion of variance in HbA_1c explained by glycemic and non-glycemic factors (age, sex, body mass index, and ethnicity).

Results

The factors in the analysis explained 35% of the variance in HbA_1c in non-diabetic individuals, 49% in T2D_{HbA1c < 6.5%}, and 78% in T2D_{HbA1c ≥ 6.5%}. In non-diabetic individuals PPG exposure was associated with HbA_1c in confounder-adjusted analyses (P < 0.05). In the T2D_{HbA1c < 6.5%} group, all glycemic measures were associated with HbA_1c (P < 0.05); preprandial glucose and PPG accounted for 14 and 18%, respectively, of the explained variation. In T2D_{HbA1c ≥ 6.5%}, these glycemic exposures accounted for more than 50% of the variation in HbA_1c and with equal relative contributions.

Conclusions

Among the glycemic exposures, PPG exposure was most strongly predictive of HbA_1c in non-diabetic individuals, suggesting that interventions targeting lowering of the PPG response may be beneficial for long-term glycemic maintenance. In T2D, preprandial glucose and PPG exposure contributed equally to HbA_1c.

中文翻译：

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糖尿病患者和非糖尿病患者餐前和餐后葡萄糖暴露，血糖变异性和非血糖因素对HbA 1c的相对贡献

背景/目标

降低饮食中餐后葡萄糖（PPG）反应的饮食方法引起了人们的极大兴趣，但是在一般人群中PPG对长期血糖控制（反映在糖化血红蛋白HbA _1c中）的定量贡献尚不明确。这项研究量化了餐前血糖暴露，PPG暴露和血糖变异性与HbA _1c的关联，并估计了患有和不患有2型糖尿病（T2D）的个体中HbA _1c的解释差异。

主题/方法

参与者A1c的衍生的平均葡萄糖（ADAG）研究而不T2D（Ñ = 77）或与非胰岛素治疗的T2D和HBA _1c的<6.5％（T2D_{的HbA1c <6.5％} ，Ñ = 63）或HBA _1C  ≥6.5％ （T2D _{HbA1c≥6.5％}，n = 34）包括在该分析中。餐前血糖，PPG和血糖变异性的指标是通过在HbA _1c测量之前的12周内的四个时段内连续监测血糖来计算的。在线性回归模型中，我们估计了血糖暴露与HbA _1c的关联，并计算了HbA _1c中的方差比例 由血糖和非血糖因素（年龄，性别，体重指数和种族）解释。

结果

分析中的因素解释了非糖尿病个体中HbA _1c变异的35％，T2D _{HbA1c <6.5％的}49％和T2D _{HbA1c≥6.5％的}78 _％。在混杂因素校正分析中，非糖尿病患者中PPG暴露与HbA _1c相关（P  <0.05）。在T2D _{HbA1c <6.5％}组中，所有血糖测量值均与HbA _1c相关（P  <0.05）；餐前葡萄糖和PPG分别占所解释变异的14％和18％。在T2D _{HbA1c≥6.5％中}，这些血糖暴露占HbA _1c变化的50％以上，并且具有相等的相对贡献。

结论

在血糖暴露中，PPG暴露最能预测非糖尿病患者的HbA _1c，这表明针对降低PPG反应的干预措施可能有益于长期血糖维持。在T2D中，餐前血糖和PPG暴露对HbA _1c的贡献相同。