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International Journal of Endocrinology
Volume 2016, Article ID 3452898, 4 pages
Research Article

Estimation of the Relative Contribution of Postprandial Glucose Exposure to Average Total Glucose Exposure in Subjects with Type 2 Diabetes

1Lund University, 22184 Lund, Sweden
2Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936-1080, USA

Received 18 April 2016; Accepted 28 July 2016

Academic Editor: Małgorzata Kotula-Balak

Copyright © 2016 Bo Ahrén and James E. Foley. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We hypothesized that the relative contribution of fasting plasma glucose (FPG) versus postprandial plasma glucose (PPG) to glycated haemoglobin (HbA1c) could be calculated using an algorithm developed by the A1c-Derived Average Glucose (ADAG) study group to make HbA1c values more clinically relevant to patients. The algorithm estimates average glucose (eAG) exposure, which can be used to calculate apparent PPG (aPPG) by subtracting FPG. The hypothesis was tested in a large dataset (comprising 17 studies) from the vildagliptin clinical trial programme. We found that 24 weeks of treatment with vildagliptin monotherapy () reduced the relative contribution of aPPG to eAG from 8.12% to 2.95% (by 64%, ). In contrast, when vildagliptin was added to metformin (), the relative contribution of aPPG to eAG insignificantly increased from 1.59% to 2.56%. In conclusion, glucose peaks, which are often prominent in patients with type 2 diabetes, provide a small contribution to the total glucose exposure assessed by HbA1c, and the ADAG algorithm is not robust enough to assess this small relative contribution in patients receiving combination therapy.