Postprandial blood glucose: The driving force in the pathogenesis of type 2 diabetes

Diabetes mellitus type 2 develops worldwide in the dimensions of an epidemic disease. In order to reduce the personal burden of patients and the enormous costs for the health system, which are mainly due to diabetes complications, diabetes prevention is urgently needed. Regarding pathophysiology, type 2 diabetes develops on the basis of insulin resistance, together with increasing reduction of insulin secretion. This leads to postprandial blood glucose peaks (Impaired Glucose Tolerance, IGT), which furthermore increase insulin resistance (metabolic resistance) and decrease insulin secretion, finally resulting in manifestation of diabetes mellitus. Therefore it is a logical way of diabetes prevention, to treat postprandial blood glucose peaks in the early stadium of IGT. The STOP-NIDDM trial showed conclusively that acarbose reduces postprandial hyperglycemia and diabetes incidence for 36% in comparison to placebo in a group of IGT patients. At the same time the incidence of normal glucose tolerance increased significantly for 30%. The NNT ("number needed to treat") for acarbose to avoid one case of diabetes manifestation in patients with IGT, is eleven patients in 3.3 years. The preventive effect of acarbose is independent of age, gender or weight of the patients. So acarbose has the potential to reduce postprandial hyperglycemia, which is the driving force for diabetes, and thus can prevent diabetes mellitus type 2.