POSTPRANDIAL HYPERGLYCEMIA AND ALPHA-GLUCOSIDASE INHIBITORS

Fasting blood glucose level is usually used to diagnose diabetes, but is not a good predictor of postprandial hyperglycaemia, which is a mor e accurate measure of the metabolic defect underlying type 2 diabetes. Postprandial blood glucose levels may be elevated while fasting level s are normal, constituting an early stage in type 2 diabetes that can be termed 'postprandial diabetes'. Prevention of postprandial hypergly caemia is important, as it is implicated in the development of macro- and microvascular complications associated with diabetes. The risk of cardiovascular disease is higher in individuals with postprandial hype rglycaemia, even without diabetes, than in individuals with normal pos tprandial blood glucose levels. Furthermore, postprandial hyperglycaem ia is implicated in the development of type 2 diabetes. Even modest po stprandial hyperglycaemia may lead to p-cell dysfunction. Agents that reduce postprandial hyperglycaemia have a key role in the treatment of type 2 diabetes and pre-diabetic states. Most anti-diabetic agents th at are currently available reduce fasting blood glucose levels, but ha ve little impact on postprandial glycaemic excursions and thus do not normalize postprandial hyperglycaemia. However, new agents that contro l postprandial hyperglycaemia have been developed, for example, the cc -glucosidase inhibitor acarbose. Such agents have a potential to reduc e the progression of diabetes as well as macro- and microvascular comp lications. (C) 1998 Published by Elsevier Science Ireland Ltd. All rig hts reserved.