The incidence of type 2 diabetes is reaching pandemic proportions, impacting patients and healthcare systems across the globe. Evidence suggests that a majority of patients are not achieving recommended blood glucose targets resulting in an increased risk of micro- and macro-vascular complications.

Glycaemic control remains fundamental to the successful management of diabetes. HbA (1c) is the gold standard measure of glycaemic control but recent evidence suggests that postmeal hyperglycaemia also plays an important role in the etiology of diabetes-associated complications and control of PPG levels is vital to the achievement of recommended HbA (1c) targets.
Woo V et al. Int J Clin Pract. 2008 Dec;62(12):1935-42.

However, studies have highlighted the importance of targeting postmeal hyperglycaemia and demonstrate a strong relationship between elevated postmeal glucose (PMG) and the risk of complications. As part of a global mission to promote diabetes care, prevention and to find a cure the post meal guideline was developed under the direction of the International Diabetes Federation.

Rationale for post meal glucose control
For the post meal guideline, post meal hyperglycaemia is defined as a plasma glucose level > 7.8 mmol/l (140 mg/dl) 2 h after the ingestion of food.
Development of post meal hyperglycaemia

		Coincides with a loss of first-phase insulin secretion
		A decrease in insulin sensitivity and
		An inability to adequately suppress hepatic glucose production

It was found that better glycemic control and prevention of diabetic complications improves these irregularities and increases fertility rates close to those that are seen in the general population. Women with persistent menstrual abnormalities despite adequate treatment need to be approached by broader evaluation, which will include

		The examination of the hypothalamic-pituitary-ovarian axis
		The hormonal status
		Presence of autoimmune thyroid disease
		Antiovarian autoantibodies, and
		Hyperandrogenism

Results: The eligible population included 1294 middle-aged individuals, and of these, 904 (406 men and 498 women) had complete data and were included in the analyses.

		Absolute adiponectin concentrations were significantly higher in women at all levels of glucose tolerance
		The gender ratio (women to men) for adiponectin concentrations decreased linearly (P = 0.011) from normal glucose tolerance (1.61; 95% CI, 1.48-1.75) to prediabetes (1.57; 95% CI, 1.36-1.83) and diabetes (1.16; 95% CI, 0.87-1.53).
		Among patients with prediabetes or diabetes, women had significantly higher concentrations than did men for hs-CRP (for prediabetes, 2.0 vs 1.5 mg/L; ratio, 1.39; 95% CI, 1.04-1.85) and IL-1RA (for prediabetes, 255 vs 178 pg/mL; ratio, 1.43; 95% CI, 1.121.83).
		The gender ratios (women to men) increased linearly from normal glucose tolerance to prediabetes and type 2 diabetes for both hs-CRP (P = 0.019) and IL-1RA (P = 0.013).

Results: Atrial fibrillation prevalence was significantly greater among patients with diabetes (3.6 vs. 2.5%, P < 0.0001). Over a mean follow-up of 7.2 +/- 2.8 years, diabetic patients without atrial fibrillation at baseline developed atrial fibrillation at an age- and sex-adjusted rate of 9.1 per 1,000 person-years (95% CI 8.6-9.7) compared with a rate of 6.6 (6.2-7.1) among nondiabetic patients.

After full adjustment for other risk factors, diabetes was associated with a 26% increased risk of atrial fibrillation among women (hazard ratio 1.26 [95% CI 1.08-1.46]), but diabetes was not a statistically significant factor among men (1.09 [0.96-1.24]). diabetes was an independent determinant of atrial fibrillation prevalence but predicted incidence only among women.
Nichols GA et al. Diabetes Care. 2009 Oct;32(10):1851-6.

		Open randomized prospective study
		Voglibose at a dose of 0.4-0.6 mg/day was added on 51 subjects out of 101 type 2 diabetic patients being treated with diet, sulphonylurea (SU) or insulin injections
		Average (Ave IMT) and maximum intima-media thickness (Max IMT) of their carotid arteries were examined for 3 years.

Results: Irrespective of the differences in treatments, addition of voglibose reduced the progression of Ave IMT and Max IMT to -0.024 +/- 0.047 (+/-S.D.) and -0.021 +/- 0.144 mm/year, respectively. Without voglibose, diabetic patients showed significant (P < 0.0001) progression of Ave IMT and Max IMT (0.056 +/- 0.046 and 0.098 +/- 0.122 mm/year, respectively).

		A significant reduction of hemoglobin A1C (HbA1c)
		Reduction in total cholesterol
		Reduction in triglyceride concentrations and
		An increase in HDL cholesterol concentration.