During this year's EASD meeting, the International Diabetes Foundation (IDF) issued a new global guideline for the management of postmeal glucose.

Noting that existing global guidelines do not include recommendations for the management of postmeal glucose, guideline presenter and co-author Stephen Colagiuri, MD, University of Sydney, Australia, said that the key questions addressed in the development of the guideline were whether post-meal hyperglycemia is actually harmful and, if so, how it can best be monitored and, if necessary, effectively treated.

The evidence used to create the guideline included findings of key meta-analyses, evidence-based reviews, individual clinical trials, cohort studies, epidemiological studies, animal and basic science studies, position statements and diabetes management guidelines.

Prof. Colagiuri said that the authors identified major research suggesting that post-meal hyperglycemia is an independent risk factor for macrovascular disease, is harmful to the person with diabetes, and should be addressed.

The new guideline suggests that people with diabetes aim for blood glucose levels less than 7.8 mmol/L (140 mg/dL) 2 hours after a meal, which is the “normal” postprandial glucose tolerance level at 2 hours as defined previously by IDF and other organizations.

The guideline recommends self-monitoring of blood glucose after meals, since it allows individuals to get relevant real-time information about their glucose levels. The authors wrote, “It is generally recommended that people treated with insulin perform self-monitoring at least 3 times per day; the frequency of self-monitoring for individuals who are not treated with insulin should be individualized to each person's treatment regimen and level of control.”

The guideline also includes information on medications that specifically target postmeal glucose levels. The authors cite “traditional” therapies including the alpha-glucosidase inhibitors, glinides, rapid-acting insulin analogs, biphasic (premixed) insulins, and human regular insulin.

They also cite new classes of therapies for the management of postmeal plasma glucose in diabetics, including amylin analogs, GLP-1 derivatives, and DPP-4 inhibitors. These therapies address pancreatic and gut hormone deficiencies affecting insulin and glucagon secretion, satiety, and gastric emptying.

A PDF of the new guideline can be found at: http://www.idf.org/webdata/docs/Guideline_PMG_final.pdf

The International Diabetes Federation (IDF) is an umbrella organization of over 200 member associations in more than 160 countries. The mission of IDF is to promote diabetes care, prevention and a cure worldwide. IDF is an NGO in official relations with the World Health Organization and an associated NGO with the United Nations Department of Public Information. Additional information about IDF is available at www.idf.org.