Post-meal time glucose spikes are to be prevented because:

• Lowering A1c reduces microvascular complications
• A1c reflects PPG as well as fasting plasma glucose levels (individuals are “postprandial” most of the 24-hour period)
• Control of PPG levels reduces intima-media thickness and decreases cardiac events (as shown in the STOP-NIDDM and other trials)
• Elevated PPG levels are a highly prevalent issue, especially in the elderly.
• Abundant experimental evidence relates acute hyperglycemia and glucose excursions to endothelial dysfunction and increased oxidative load.
• Elevated blood glucose levels 2 hours after a glucose load are associated with an increased risk for death, independent of fasting blood glucose levels (even in non-diabetic persons). The European Prospective Investigation into Cancer Study–Norfolk cohort study further raises questions as to the level of A1c associated with increased risk.