Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Oct 10, 2015; 6(13): 1243-1245
Published online Oct 10, 2015. doi: 10.4239/wjd.v6.i13.1243
In treating diabetes, what is important? Glucose levels or outcome measures?
Anil K Mandal
Anil K Mandal, Mandal Diabetes Research Foundation, Saint Augustine, FL 32084, United States
Anil K Mandal, Nephrology, North East Florida Area Hospitals, Saint Augustine, Palatka, FL 32177, United States
Anil K Mandal, Medicine, University of Florida, Gainesville, FL 32608, United States
Anil K Mandal, Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
Author contributions: Mandal AK solely contributed to this manuscript.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Anil K Mandal, MB, BS, Consultant in Nephrology, Courtesy Clinical Professor of Medicine, Adjunct Professor of Pathology and Laboratory Medicine, Mandal Diabetes Research Foundation, 665 SR 207, Suite 102, Saint Augustine, FL 32084, United States. amandal@med-spec.com
Telephone: +1-904-8248158 Fax: +1-904-8231284
Received: January 8, 2015
Peer-review started: January 10, 2015
First decision: March 6, 2015
Revised: April 8, 2015
Accepted: September 25, 2015
Article in press: September 28, 2015
Published online: October 10, 2015
Abstract

Gaps in knowledge prevail in recognizing which glycemic parameters to order and in determining glycemic control. However glycosylated hemoglobin (HbA1c) is most commonly ordered to determine glycemic control. HbA1c provides information of overtime glycemic control but does not inform post meal glycemic excusions. The latter may be significant in outcome measure such as cardiovascular disorder (CVD), renal failure or amputation in diabetes. In order to obviate the dilemma in the importance between fasting blood glucose (FBG) and 2-h post prandial glucose (2hPPG), we innovated delta (d) which is the difference between 2hPPG minus FBG. There is much information available relating 2hPPG or postprandial hyperglycemia to CVD and some information relating 2hPPG to renal failure or amputation. Thus much emphasis is laid upon glycemic control with little or no emphasis on the complications of diabetes or the outcome measures. The focus of this editorial is to draw attention to outcome measures by ordering fasting and 2-h postprandial (2hPP) basic metabolic panel (BMP) which provides glucose levels, renal function test and electrolytes. HbA1c significantly relates to 2hPPG, thus by ordering F and 2hPP BMP instead of HbA1c alone will serve both purposes: Glycemic control and outcome measure. Delta (d) glucose (dhPPG-FBG) is a stronger predictor than 2hPPG of renal function deterioration.

Keywords: Diabetes, Outcome measures, Amputation, Renal failure, Glycosylated hemoglobin, Postprandial hyperglycemia, 2-h postprandial glucose

Core tip: Postprandial glucose level (2-h after major meal: Breakfast or lunch) is the cornerstone of laboratory test for diabetes to monitor glycemic control and prognosticate development or progression of diabetic complications.