New data highlight impact of post-meal hyperglycaemia on people with diabetes

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VANCOUVER, Canada, December 2 /PRNewswire=KYODO JBN/ --

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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).

    To view the Multimedia News Release, please click:

http://www.multivu.com/players/uk/7700051-post-meal-hyperglycaemia-diabetes

    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

(less than or equal to6.5%), 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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    SOURCE: Novo Nordisk