isolated post - prandial hyperglycemia ( pphg ) , as occurs in impaired glucose tolerance ( igt ) , has been shown to double the risk for cardiovascular ( cv ) mortality .
pphg also appears to be the rate limiting factor for achieving optimal glycemic control in t2 dm .
the magnitude and time of the peak plasma glucose ( pg ) depends on a variety of factors , including the timing , quantity and composition of the meal . in non - diabetic individuals , pg peaks
about 60 minutes after the start of a meal , rarely exceeds 140 mg / dl , and returns to pre - prandial levels within 2  3 hours .
observed that in diabetics with hba1c<7% , 80% had pppg>200 mg/ dl and 17% had fpg>126 mg / dl , whereas in individuals with hba1c>8% , the corresponding figures were 100% ( pp ) and 99% ( fasting ) .
found that the relative contribution of pppg was higher ( 70% ) in patients with fairly good control of diabetes ( hba1c < 7.3% ) and decreased progressively ( 30% ) with worsening diabetes ( hba1c>10.2% ) .
decreases in ppg accounted for nearly twice the decrease in hba1c compared with decreases in fpg .
there are different targets for pppg control : < 180 mg/ dl ( ada ) ; < 140 mg / dl ( aace ) ; idf target is 145 mg / dl ( plasma ) and 160 mg / dl ( capillary ) .
plasma 1,5  anhydro  glucitol ( 1,5  ag ) best reflects 2 h ppg of the previous 2 weeks .
the harmful effects of pppg are related to ros and mediated by pkc , age , polyol and hexoseamine pathway . 

have shown that pppg appears to have a linear relation with cvd , even across the non - diabetic range . in decoda , 2 h ppg was superior to fpg in predicting premature cvd mortality . in a recently published meta - analysis , the pooled relative risk for cvd was 1.18 , representing a 1% increase in hba1c in persons with t2 dm [ figure 1 and 2 ] .
controlling pphg has been demonstrated to improve myocardial flow and function.pphg and oxidative stress , inflammation , and endothelial dysfunction : treating post - prandial hyperglycemia can improve oxidative stress , inflammation , endothelial dysfunction , and thrombosis.pphg and cimt : carotid intima  media thickness ( cimt ) was significantly increased in the top quintile of 2 h pppg ( 148  200 mg / dl).pphg and micro - vascular complications : pphg had a stronger correlation with the incidence of diabetic microangiopathy compared with hba1c levels.pphg and cognitive function : exaggerated ppg excursions are associated with a derangement of both global , executive and attention functioning.pphg and cancer : pphg and factors known to promote post - meal hyperglycemia are implicated in the development of cancer . 
 
have shown that pppg appears to have a linear relation with cvd , even across the non - diabetic range . in decoda , 2 h ppg was superior to fpg in predicting premature cvd mortality . in a recently published meta - analysis , the pooled relative risk for cvd was 1.18 , representing a 1% increase in hba1c in persons with t2 dm [ figure 1 and 2 ] .
pphg and oxidative stress , inflammation , and endothelial dysfunction : treating post - prandial hyperglycemia can improve oxidative stress , inflammation , endothelial dysfunction , and thrombosis .
pphg and cimt : carotid intima  media thickness ( cimt ) was significantly increased in the top quintile of 2 h pppg ( 148  200 mg / dl ) .
pphg and micro - vascular complications : pphg had a stronger correlation with the incidence of diabetic microangiopathy compared with hba1c levels .
pphg and cognitive function : exaggerated ppg excursions are associated with a derangement of both global , executive and attention functioning .
pphg and cancer : pphg and factors known to promote post - meal hyperglycemia are implicated in the development of cancer .
contribution of pphg to hba1c mechanisms of pphg - induced harmful effects a variety of both non  pharmacologic and pharmacologic therapies should be considered to target ppg .
therapies which are available for pphg include agi , glinides , short - acting su ( glipizide ) , and rapidly acting human insulins/ insulin analogues and biphasic ( pre - mixed ) insulins / insulin analogues , dpp4 inhibitors , and glp -1 derivatives .
one of the earlier studies to show that targeting pphg has the potential to improve clinical outcome was done by de veciana et al . who found that pregnant women with gdm requiring insulin therapy did better when pppg rather than fpg was used to guide management .
reported that insulin aspart reduced pp oxidative stress more effectively than regular insulin in patients with t2 dm .
found a highly significant correlation between pppg , excursions and age in t1 dm subjects . in a small study , once 
daily glipizide gits , twice - daily immediate - release glipizide , or thrice - daily nateglinide resulted in equivalent control of pppg in type 2 dm . in a seminal study organized by the campanian post - prandial hyperglycemia study group ,
the reduction in cimt was associated with changes in pphg but not fasting hyperglycemia , and those who had the greatest reduction in pphg had the greatest cimt regression . in this study ,
repaglinide was more effective in blunting the ppg peak and showed greater cimt regression and greater reduction in il  6 and crp compared with glyburide .
the stop  niddm trial , in patients with igt , found a 49% rr reduction for any cv event in patients treated with acarbose over a mean follow  up of 3.3 years .
, there was a significant 35% rr reduction for any cv event and 64% rr reduction for myocardial infarction with acarbose .
there may be enhancement of post - prandial glucose control and some diminution of fasting glucose control with shorter  acting glp  1 receptor agonist ( exenatide bid ) compared to longer - acting agonist ( exenatide once  weekly , liraglutide ) .
2 h pppg decreased by a mean 76 mg / dl when patients switched from sitagliptin to exenatide ( and increased by 73 mg / dl when the reverse switch was made ) .
post - prandial glucose after supper and breakfast were significantly lower in t2 dm taking vildagliptin ( 100 mg/ day ) than those taking sitagliptin ( 100 mg / day ) who had lower glucose level after dinner .
rizzo et al . reported that reductions in oxidative stress and markers of inflammation were greater in t2 dm patients taking vildagliptin than those taking sitagliptin .
there is currently a lack of direct randomized clinical trial evidence that correcting post - meal hyperglycemia improves clinical outcomes .
the heart 2d study , assigned t2 dm patients to prandial ( lispro ) and basal ( nph or glargine ) strategy , did not show a beneficial effect of preferentially treating pphg in reducing further cv events in people with diabetes who had an acute mi . a recent post - hoc analysis
, however , suggested that older patients may have a lower risk for a subsequent cv event .
pphg makes a significant contribution to overall glycemia reflected in the hba1c level , and blood glucose lowering therapy should preferentially choose an agent , which specifically lowers ppg .

 pphg and cv mortality : studies by levitan et al . have shown that pppg appears to have a linear relation with cvd , even across the non - diabetic range . in decoda , 2 h ppg was superior to fpg in predicting premature cvd mortality . in a recently published meta - analysis ,
the pooled relative risk for cvd was 1.18 , representing a 1% increase in hba1c in persons with t2 dm [ figure 1 and 2 ] .
controlling pphg has been demonstrated to improve myocardial flow and function.pphg and oxidative stress , inflammation , and endothelial dysfunction : treating post - prandial hyperglycemia can improve oxidative stress , inflammation , endothelial dysfunction , and thrombosis.pphg and cimt : carotid intima 
media thickness ( cimt ) was significantly increased in the top quintile of 2 h pppg ( 148  200 mg / dl).pphg and micro - vascular complications : pphg had a stronger correlation with the incidence of diabetic microangiopathy compared with hba1c levels.pphg and cognitive function : exaggerated ppg excursions are associated with a derangement of both global , executive and attention functioning.pphg and cancer : pphg and factors known to promote post - meal hyperglycemia are implicated in the development of cancer . 
 
have shown that pppg appears to have a linear relation with cvd , even across the non - diabetic range . in decoda , 2 h ppg was superior to fpg in predicting premature cvd mortality . in a recently published meta - analysis ,
the pooled relative risk for cvd was 1.18 , representing a 1% increase in hba1c in persons with t2 dm [ figure 1 and 2 ] .
pphg and oxidative stress , inflammation , and endothelial dysfunction : treating post - prandial hyperglycemia can improve oxidative stress , inflammation , endothelial dysfunction , and thrombosis .
pphg and cimt : carotid intima  media thickness ( cimt ) was significantly increased in the top quintile of 2 h pppg ( 148  200 mg / dl ) .
pphg and micro - vascular complications : pphg had a stronger correlation with the incidence of diabetic microangiopathy compared with hba1c levels .
pphg and cognitive function : exaggerated ppg excursions are associated with a derangement of both global , executive and attention functioning .
pphg and cancer : pphg and factors known to promote post - meal hyperglycemia are implicated in the development of cancer .
a variety of both non  pharmacologic and pharmacologic therapies should be considered to target ppg .
therapies which are available for pphg include agi , glinides , short - acting su ( glipizide ) , and rapidly acting human insulins/ insulin analogues and biphasic ( pre - mixed ) insulins / insulin analogues , dpp4 inhibitors , and glp -1 derivatives .
one of the earlier studies to show that targeting pphg has the potential to improve clinical outcome was done by de veciana et al . who found that pregnant women with gdm requiring insulin therapy did better when pppg rather than fpg was used to guide management .
reported that insulin aspart reduced pp oxidative stress more effectively than regular insulin in patients with t2 dm .
found a highly significant correlation between pppg , excursions and age in t1 dm subjects . in a small study , once 
daily glipizide gits , twice - daily immediate - release glipizide , or thrice - daily nateglinide resulted in equivalent control of pppg in type 2 dm . in a seminal study organized by the campanian post - prandial hyperglycemia study group ,
the reduction in cimt was associated with changes in pphg but not fasting hyperglycemia , and those who had the greatest reduction in pphg had the greatest cimt regression . in this study ,
repaglinide was more effective in blunting the ppg peak and showed greater cimt regression and greater reduction in il  6 and crp compared with glyburide .
the stop  niddm trial , in patients with igt , found a 49% rr reduction for any cv event in patients treated with acarbose over a mean follow  up of 3.3 years .
, there was a significant 35% rr reduction for any cv event and 64% rr reduction for myocardial infarction with acarbose .
there may be enhancement of post - prandial glucose control and some diminution of fasting glucose control with shorter  acting glp  1 receptor agonist ( exenatide bid ) compared to longer - acting agonist ( exenatide once  weekly , liraglutide ) .
2 h pppg decreased by a mean 76 mg / dl when patients switched from sitagliptin to exenatide ( and increased by 73 mg / dl when the reverse switch was made ) .
post - prandial glucose after supper and breakfast were significantly lower in t2 dm taking vildagliptin ( 100 mg/ day ) than those taking sitagliptin ( 100 mg / day ) who had lower glucose level after dinner .
rizzo et al . reported that reductions in oxidative stress and markers of inflammation were greater in t2 dm patients taking vildagliptin than those taking sitagliptin .
there is currently a lack of direct randomized clinical trial evidence that correcting post - meal hyperglycemia improves clinical outcomes .
the heart 2d study , assigned t2 dm patients to prandial ( lispro ) and basal ( nph or glargine ) strategy , did not show a beneficial effect of preferentially treating pphg in reducing further cv events in people with diabetes who had an acute mi . a recent post - hoc analysis , however , suggested that older patients may have a lower risk for a subsequent cv event .
pphg makes a significant contribution to overall glycemia reflected in the hba1c level , and blood glucose lowering therapy should preferentially choose an agent , which specifically lowers ppg .
 isolated post prandial hyperglycaemia ( pphg ) has been shown to double the risk for cardiovascular mortality . 
 it also makes a significant contribution to overall glycaemia reflected in the hba1c level . 
 the harmful effects of pphg are increased cardiovascular mortality , association with mic rovascular complications , cognitive decline and cancers . a variety of both pharmacologic and non - pharmacologic trherapies are available to target pphg . 