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The degree to which FPG and PPG influence overall glycaemia is rela-
tively complex, but we know that PPG contributes ~70% to the total
glycaemic load in patients who are fairly well controlled (HbA <7.3%).
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In patients who are very poorly controlled (HbA >10.2) it is FPG that
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contributes around 70% to the total glycaemic load (Figure 1). Further-
7, 9
more, there is a Iinear relationship between the risk of CV death and the
2-hour oral glucose tolerance test (OGTT). These data suggest that all
7
the parameters for assessing glycaemia (HbA , FPG, and PPG) should
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be considered in the management of T2DM. In assessing the efficacy of
7
a T2DM therapy we should take into account not only its ability to lower
HbA , but also its ability to normalise the blood glucose excursions that
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can occur during the day i.e. the spikes in FPG and PPG. 10, 11

Figure 1. Relative contributions of PPG (dark blue) and FPG (light blue) to the overall
diurnal hyperglycaemia over quintiles of HbA . 9
1c

Beyond glycaemic measures in assessing treatment efficacy

In addition to glycaemic parameters for assessing the efficacy of T2DM
treatment, it is becoming increasingly clear that other parameters be-
yond glycaemic control are important. T2DM is a complex condition
that is often part of a much broader metabolic syndrome that mani-
fests itself with obesity, hypertension and dyslipidaemia. Also, the side
effects associated with some treatments can have a negative impact
on the patient’s quality of life.
12

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