Atherosclerotic disease accounts for much of the increased mortality and morbidity associated with type 2 diabetes. Epidemiological studies support the potential of improved glycemic control to reduce cardiovascular complications. An association between glycosylated hemoglobin (HbA1c) level and the risk for cardiovascular complications has frequently been reported. Most epidemiological data implicate postprandial hyperglycemia in the development of cardiovascular disease, whereas the link between fasting glycemia and diabetic complications is inconclusive. Moreover, in many studies, postprandial glycemia is a better predictor of cardiovascular risk than HbA1c level. Postprandial glucose may have a direct toxic effect on the vascular endothelium, mediated by oxidative stress that is independent of other cardiovascular risk factors such as hyperlipidemia. Postprandial hyperglycemia also may exert its effects through its substantial contribution to total glycemic exposure. The present review examines the hypothesis that controlling postprandial glucose level is an important strategy in the prevention of cardiovascular complications associated with diabetes.
Hazard ratios (dots) for all-cause (A) and cardiovascular (B) mortality by 2-hour postchallenge glucose levels in the DECODE (Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe) Study. Hazard ratios are adjusted for age, sex, blood pressure, smoking, serum cholesterol level, body mass index, and study center. Bars signify 95% confidence intervals. To convert glucose levels to millimoles per liter, multiply by 0.0555. Adapted from DECODE Study Group.20
Effectiveness of acarbose against the development of cardiovascular disease in the STOP Noninsulin-Dependent Diabetes Mellitus trial. Adapted from Chiasson et al.23 CI indicates confidence interval; dots, hazard ratios; and bars, 95% CI. Hazard ratio and P value were not calculated for congestive heart failure.
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