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

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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.mult
ivu.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 (<=6.5%), 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.pd
f. Last accessed: October 2015.

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