The contribution of postprandial glucose (PPG) excursions to the overall hyperglycemia of patients with type 2 diabetes depends
on the degree of diabetic control. PPG is a major contributor in patients with hemoglobin A
1c (HbA
1c) levels below 7.3%, whereas the contribution of fasting plasma glucose (FPG) is preponderant in poorly controlled patients.
In addition, the loss of postprandial glycemic control precedes stepwise degradation of fasting with worsening diabetes. As
a consequence, monitoring after meals is particularly important in patients with HbA
1c levels ranging from 6.5% to 8%. In such patients, targeting PPG below 140 mg/dL should be one of the main objectives to achieve
HbA
1c less than 6.5%. The new hypoglycemic agents, such as the glucagon-like peptide-1 analogues and the dipeptidyl peptidase-4
inhibitors which have a gluco-dependent insulinotropic effect, should normally reinforce our therapeutic armamentarium for
achieving the glycemic targets that should include the three components of the glucose triad: HbA
1c, FPG, and PPG.