A large study appears to have answered the question of whether it’s more important to control fasting blood glucose levels or  postprandial spikes. Neither approach shows a significant benefit in preventing the progression of heart disease.

A lack of efficacy halted the study of 1,115 individuals after an average of 2.7 years of participation. The patients were taking part in the multinational Hyperglycemia and Its Effect After Acute Myocardial Infarction on Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus (HEART2D) trial (Diabetes Care. 2009;32:381-386; accessed May 14, 2009).

All study participants (aged 30-75 years) had type 2 diabetes. Each had suffered an acute MI within the preceding three weeks and were randomly assigned to one of two treatment approaches: The prandial strategy comprised three premeal doses of insulin lispro, targeting two-hour postprandial blood glucose <135 mg/dL, and the basal strategy provided isophane insulin twice daily or glargine once daily, targeting fasting/premeal blood glucose <120.6 mg/dL.

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In the end, the differences in postprandial blood glucose between the two groups was less than expected, hemoglobin A1c levels were similar, and there was no difference in the risk for future CV events.