Electronic Letters to:

Article: Katherine Esposito, Miryam Ciotola, Diego Carleo, Bruno Schisano, Luigi Sardelli, Domenico Di Tommaso, Lucio Misso, Franco Saccomanno, Antonio Ceriello, and Dario Giugliano Postmeal glucose peaks at home associate with carotid intima-media thickness in type 2 diabetes J Clin Endocrinol Metab 2008; 0: jc.2007-2000v1 [Abstract]

eLetters: Submit a response to this article

Electronic letters published:

Letter to the Editor

Sho-ichi Yamagishi   (30 April 2008)

Letter to the Editor 30 April 2008
Sho-ichi Yamagishi, Professor Kurume University School of Medicine Send letter to journal: Re: Letter to the Editor shoichi{at}med.kurume-u.ac.jp Sho-ichi Yamagishi	I read with interest the recent study by Esposito et al. (1), which reported that post-meal glucose peaks at home were associated with carotid intima-media thickness (CIMT) in type 2 diabetes (1). As far as I know, this is the first paper to show that incremental glucose peak (IGP), which was defined as the maximal incremental increase in blood glucose obtained at any time after the main meal and assessed at home in a free living condition, was correlated with CIMT more than markers currently used to define postprandial hyperglycemia, such as 2-h blood glucose concentration after the meal. The authors should also take the timing of postprandial spikes in lipids into account because there is accumulating evidence that postprandial lipidemia elicits vascular inflammation and endothelial dysfunction via oxidative stress generation in diabetes and that the postprandial changes last a long time after the meal (2-4). Indeed, postprandial hypertriglycelidemia has been observed maximally at 2-6 h after the meal in diabetic patients, which is positively correlated with thiobarbituric acid-reactive substances, an indicator of lipid peroxides in plasma and decreased flow-mediated artery dilatation, one of the markers of endothelial dysfunction (2-4). As Dr. Ceriello, one of the authors in the JCEM paper, previously reported (4), postprandial hyperglycemia and hypertriglyceridemia had an independent and cumulative effect on endothelial function via oxidative generation in type 2 diabetic patients. These observations suggest that altered postprandial metabolism, including hyperglycemia and hyperlipidemia, could totally affect the progression of atherosclerosis in diabetes. Therefore, a 1-h glucose reading after meal may not fully reflect the cardiovascular risk associated with postprandial derangements, whereas two-hour postprandial hyperglycemia and hyperlipidemia could be a stronger predictor of CIMT. Further study is needed to clarify which one is the best postprandial biomarker for CIMT and future cardiovascular events in type 2 diabetes. References 1. Esposito K, Ciotola M, Carleo D, Schisano B, Sardelli L, Tommaso DD, Misso L, Saccomanno F, Ceriello A, Giugliano D 2008 Post-meal glucose peaks at home associate with carotid intima-media thickness in type 2 diabetes. J Clin Endocrinol Metab 93:1345-1350 2. Saxena R, Madhu SV, Shukla R, Prabhu KM, Gambhir JK 2005 Postprandial hypertriglyceridemia and oxidative stress in patients of type 2 diabetes mellitus with macrovascular complications. Clin Chim Acta 359:101-108 3. Anderson RA, Evans ML, Ellis GR, Graham J, Morris K, Jackson SK, Lewis MJ, Rees A, Frenneaux MP 2001 The relationships between post- prandial lipaemia, endothelial function and oxidative stress in healthy individuals and patients with type 2 diabetes. Atherosclerosis 154:475-483 4. Ceriello A, Taboga C, Tonutti L, Quagliaro L, Piconi L, Bais B, Da Ros R, Motz E 2002 Evidence for an independent and cumulative effect of postprandial hypertriglyceridemia and hyperglycemia on endothelial dysfunction and oxidative stress generation: effects of short- and long-term simvastatin treatment. Circulation 106:1211-1218