Assessment of glycemic control: new insights into the evaluation of the diabetic patient

Diabetes mellitus is an increasingly prevalent worldwide disease, complicated by development of micro- and macro-angiopathy and associated with high morbidity and mortality. Several studies have demonstrated a direct correlation between improvement of metabolic control and a reduced risk of chronic complications, especially microangiopathy. Glycemic control in type 2 diabetes (DM2) patients focuses primarily on the assessment of three parameters: glycated hemoglobin (HbA1c), fasting plasma glucose (FPG) and postprandial glucose (PPG). Currently, HbA1c is regarded as the gold standard for assessing glycemic control, due to the large experience regarding the reduction of chronic complication risks. However, there is growing evidence that acute glucose fluctuations could also be involved in the pathogenesis of chronic complications. It has therefore been suggested that treatment decisions should not be based exclusively on HbA1c, but should also take into account glycemic variability. Recently, several studies have advocated the use of PPG (either as an isolated value or as a component of glycemic variability) as a more accurate way of estimating glycemic control in patients with diabetes.