Context Two-hour postprandial hyperglycemia is related to chronic complications of diabetes and is currently used in the international guidelines to drive the therapy.

Objective To assess size and timing of postmeal glucose peaks in every day life of type 2 diabetic patients, and the relationship with carotid atherosclerosis

Design, Setting, and Patients: This was an observational study carried out in 644 outpatients with type 2 diabetes attending Diabetes Clinics located in the area of the Campania County, South Italy, who provided complete home blood glucose profiles and centralized carotid intima-media thickness (CIMT) assessment. The study was conducted from 2001 to 2005.

Main Outcomes Measures Incremental glucose peak (IGP) was the maximal incremental increase in blood glucose obtained at any point following the meal. CIMT was assessed by carotid sonography.

Results The level of hemoglobin A1c and CIMT progressively increased across quintiles of IGP (P for trend = 0.01 for both). In univariate analysis, all examined glycemic parameters were significantly correlated with CIMT. IGP (r = 0.40, P = 0.006) showed the strongest correlation with CIMT which remained significant in multiple linear regression analysis (R² = 0.26, P = 0.01). IGP was associated with a significant rise of CIMT in tertiles of HbA1c. IGP occurred within one hour from the start of the meal in 95% of the entire diabetic population.

Conclusions IGPs are frequent in every day life of type 2 diabetes, occur for the most (95%) within one hour after meal and timing is not influenced by treatment (diet or drugs), and correlate with CIMT.