New data highlight impact of post-meal hyperglycaemia on people with diabetes
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Abstracts: 0720-P, 0721-P, 1074-P, 0956-P
New data from four analyses[1],[2],[3],[4] demonstrate that post-meal hyperglycaemia (when blood sugar goes too high after eating) is associated with a negative physical and emotional impact on people with type 1 and type 2 diabetes[3], greater use of healthcare resources[1], missed work time and reduced productivity[4]. These results were presented today at the World Diabetes Congress of the International Diabetes Federation (IDF).
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Nearly two thirds (561 out of 906) of participants in two of the analyses experienced post-meal hyperglycaemia in the past week prior to participation in the study[1],[2] and almost one third (272 out of 906) experienced post-meal hyperglycaemia three or more times in the same period[1],[2]. Post-meal glucose control is an important contributor to achieving overall HbA1c targets[5] and, by this, helps to reduce the risk of long-term diabetes-related complications[6].
"It is important in diabetes management to get the balance right in blood glucose control. Post-meal hyperglycaemia is a persistent challenge due to the limitations of current methods of insulin delivery, yet until now there has been limited research into its implications and the experience for people living with diabetes," said Professor Simon Heller, Professor of Clinical Diabetes at Sheffield University and lead author on one of the studies. "These data support the need for more research in this area to help patients and healthcare professionals understand the importance of post-meal blood glucose control."
The experience of post-meal hyperglycaemia was associated with economic implications[1],[4], including an effect on working life for working people with diabetes, with 27% missing work time and 71% reporting work productivity issues[4]. In addition, those experiencing post-meal hyperglycaemia made more use of healthcare resources, having significantly greater contact with healthcare professionals (5.5 visits in the past year prior to participation in the study) compared to those not experiencing post-meal hyperglycaemia (4.4 visits in the same period)[1]. People who experienced post-meal hyperglycaemia in the past week measured their blood glucose significantly more frequently than those who did not (average extra measurement per day 1.9 vs 1.2, p<0.001)[1]. People with diabetes experiencing post-meal hyperglycaemia were also more likely to report diabetes related medical complications[1].
People with type 1 and type 2 diabetes also reported a number of daily life situations as potential contributing factors for experiencing post-meal hyperglycaemia, including stress (27%), eating out at a restaurant (25%), being busy (21%) and feeling tired (19%)[2]. The experience of post-meal hyperglycaemia was associated with a number of uncomfortable symptoms including physical impacts, such as tiredness and dizziness, emotional and cognitive impacts, sometimes leaving people with diabetes feeling demoralised, unsociable and irritable[3]. As a result, people reported an impact on a range of daily life activities, including in their working and social life, cognition and ability to drive[3].
About the studies
Three of the analyses investigated data collected from a web survey among 906 adults with type 1 (n=356) and type 2 (n=550) diabetes receiving self-administered mealtime insulin in the US (n=365), UK (n=236), and Germany (n=305). The analyses assessed the impact of respondent-reported post-meal hyperglycaemia on healthcare resource use[1], missed work and work productivity[4], and the experience of post-meal hyperglycaemia, causes, contributing situations and corrective actions following episodes[2].
The other study used a qualitative approach with one-to-one interviews and focus groups with 24 people in the UK and US aged 18 years and over with type 1 or type 2 diabetes receiving insulin therapy. Data were collected via telephone interviews and focus groups to provide insight into whether people experienced post-meal hyperglycaemia and how it affected them[3].
These studies were funded by Novo Nordisk.
About post-meal glucose
Post-meal or post-prandial glucose (also known as PPG) is the level of blood glucose concentration measured 1-2 hours after eating. It is an important factor to consider in achieving overall blood glucose control in diabetes.
The use of a mealtime insulin primarily seeks to control PPG, and therapy with a basal (long-acting) insulin primarily seeks to control blood glucose between meals and overnight, including fasting plasma glucose (FPG)[7],[8].
About post-meal hyperglycaemia
In diabetes, the body cannot produce enough or cannot respond to insulin. This means glucose can stay in the bloodstream. When blood glucose levels become too high it is known as hyperglycaemia. When blood glucose levels are higher than target levels two hours after eating, this is considered post-meal hyperglycaemia.
There is a lack of consensus between various guidelines regarding recommended PPG target levels. ADA guidelines recommend a PPG target of <10 mmol/L (180 mg/dL) to help lower HbA1c[9]. AACE/ACE guidelines recommend an out-patient target of <7.8 mmol/L (140 mg/dL) to achieve target HbA1c levels (<=6.5%), and 7.8 to 10 mmol/L (140 to 180 mg/dL) for hospitalised patients in the intensive care unit (ICU) and <10 mmol/L (180 mg/dL) for hospitalised patients not in the ICU, provided this can be done safely[10]. IDF guidelines recommend PPG be measured 1-2 hours after a meal. The target for PPG is 9.0 mmol/l (160 mg/dL), as long as hypoglycaemia is avoided[11].
About Novo Nordisk
Novo Nordisk is a global healthcare company with more than 90 years of innovation and leadership in diabetes care. This heritage has given us experience and capabilities that also enable us to help people defeat other serious chronic conditions: haemophilia, growth disorders and obesity. Headquartered in Denmark, Novo Nordisk employs approximately 40,300 people in 75 countries and markets its products in more than 180 countries. For more information, visit novonordisk.com (http://www.novonordisk.com/), Facebook (http://www.facebook.com/novonordisk), Twitter (http://www.twitter.com/novonordisk), LinkedIn (http://www.linkedin.com/company/novo-nordisk), YouTube (http://www.Youtube.com/novonordisk)
References
1. Brod M, et al. Post-prandial hyperglycaemic episodes and healthcare resource use among people with diabetes in the US, UK and Germany. Research supported by Novo Nordisk. Presented at the World Diabetes Congress (Poster #0720-P), 30 November - 4 December 2015.
2. Pfeiffer KM, et al. The impact of post-prandial hyperglycaemia (PPH) on diabetes management. Research supported by Novo Nordisk. Presented at the World Diabetes Congress (Poster #1074-P), 30 November - 4 December 2015.
3. Heller S, et al. Towards a better understanding of acute post-prandial hyperglycaemic episodes: A qualitative study. Study conducted by ICON Patient Reported Outcomes under a consulting agreement with Novo Nordisk A/S. Presented at the World Diabetes Congress (Poster #0956-P), 30 November - 4 December 2015.
4. Brod M, et al. Post-prandial hyperglycaemia (PPH): Missed work time and reduced productivity among people with diabetes. Research supported by Novo Nordisk. Presented at the World Diabetes Congress (Poster #0721-P), 30 November - 4 December 2015.
5. Monnier, et al. Postprandial and basal glucose in type 2 diabetes: Assessment and respective impacts. Diabetes Technology & Therapeutics 2011;13(S1):25-32.
6. Ceriello A, et al. Guideline for management of postmeal glucose. Nutrition, Metabolism & Cardiovascular Diseases 2008;18:S17-33.
7. DeWitt DE and Hirsch IB. Outpatient insulin therapy in type 1 and type 2 diabetes mellitus: Scientific review. JAMA 2003;289(17):2254-2264.
8. American Association of Clinical Endocrinologists (AACE). Diabetes resource centre. Treatment of Type 1 Diabetes. Available at: http://outpatient.aace.com/type1-diabetes/treatment. Last accessed: October 2015.
9. American Diabetes Association. Standards of medical care in diabetes-2015. Diabetes Care 2015;38(suppl 1):S1-S93.
10. Handelsman Y, et al. American Association of Clinical Endocrinologists and American College of Endocrinology - clinical practice guidelines for developing a diabetes mellitus comprehensive care plan - 2015. Endocrine Practice 2014;21(Suppl 1).
11. International Diabetes Federation (IDF). Guideline for Management of Post Meal Glucose in Diabetes. 2011. Available at: http://www.idf.org/sites/default/files/postmeal%20glucose%20guidelines.pdf. Last accessed: October 2015.
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