This article reviews different glycemic parameters and is aimed to clarify the most dependable
glycemic parameter that predicts renal preservation. Glycosylated hemoglobin (HbA1c) and fasting
blood glucose (FBG) are the most commonly ordered tests for the diagnosis of diabetes and are
also used to indicate prevention of microvascular complications associated with diabetes. Some experts
have concluded that HbA1c remains the only test that can predict microvascular complications
but HbA1c is misleading with anemia. Other experts have reported that elevation of 2 hour postprandial glucose (2hPPG)
or postprandial hyperglycemia is critical for the development of diabetic complications
Measurement of parameters under fasting conditions is convenient in both clinical and research settings and are used to
establish clinical guidelines for diabetes management and for rating efficacy of management. Despite the use of these diagnostic
markers and a plethora of oral antidiabetic agents to treat diabetes, diabetic complications namely; cardiovascular
disorders (CVD), end stage renal disease (ESRD) and amputation are on the rise.
Although affirmative data on many of the complications are not available, the United States Renal Data System on ESRD
is a testimonial to poor diabetes care. We have innovated dglucose (2hPPG-FBG) and found that dglucose relates significantly
to renal function change measured by serum creatinine levels or estimated glomerular filtration rate. Our current
study on dglucose confirms our previous finding and validates the importance of dglucose to aid in the management of
diabetes and prevents diabetic complications.
In conclusion, the new finding in this study is dglucose (2h-postprandial glucose-Fasting glucose) which convincingly relates
to renal function changes. Since dglucose is a product of 2hPP glucose, keeping 2hPPG under tight control with intensive
insulin therapy is fundamentally important. Further blood pressure control avoiding the use of renin-angiotensin
inhibitor therapy is additive to renal protection in diabetes.