The postprandial glycemic response (PPGR) is associated with diabetes and cardiovascular disease and is highly individualized. The PPGR is affected by both physiological and behavioral factors. Attention to the PPGR has dramatically increased recently with the widespread use of continuous glucose monitors. It is expected that individualized control of PPGRs will be important in the prevention of diabetes and its associated complications. In this article, we discuss six modifiable factors associated with the PPGRs, including (1) the glucoregulatory hormones, (2) gastric emptying, (3) salivary or pancreatic amylase, (4) diet, (5) physical exercise, and (6) sleep and circadian rhythm. Modifying these factors may allow for personalized intervention strategies to control the PPGR—to reduce the risk for cardiovascular disease in individuals with varying degrees of glycemia.
HiyoshiTFujiwaraMYaoZ. Postprandial hyperglycemia and postprandial hypertriglyceridemia in type 2 diabetes. J Biomed Res. 2017;33(1):1-16. doi:10.7555/JBR.31.20160164.
2.
DECODE Study Group, The European Diabetes Epidemiology Group. Glucose tolerance cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med. 2001;161(3):397. doi:10.1001/archinte.161.3.397.
3.
SotteroBGargiuloSRussoIBaraleCPoliGCavalotF. Postprandial dysmetabolism and oxidative stress in type 2 diabetes: pathogenetic mechanisms and therapeutic strategies. Med Res Rev. 2015;35(5):968-1031. doi:10.1002/med.21349.
4.
HoffmanRP. Hyperglycemic endothelial dysfunction: does it happen and does it matter. J Thorac Dis. 2015;7(10):1693-1695. doi:10.3978/j.issn.2072-1439.2015.10.24.
5.
NodeKInoueT. Postprandial hyperglycemia as an etiological factor in vascular failure. Cardiovasc Diabetol. 2009;8:23. doi:10.1186/1475-2840-8-23.
6.
ShahimBDe BacquerDDe BackerG, et al. The prognostic value of fasting plasma glucose, two-hour postload glucose, and HbA1c in patients with coronary artery disease: a report from EUROASPIRE IV: a survey from the European Society of Cardiology. Diabetes Care. 2017;40(9):1233-1240. doi:10.2337/dc17-0245.
7.
ShaheenASadiyaAMussaBMAbusnanaS. Postprandial glucose and insulin response to meal sequence among healthy UAE adults: a randomized controlled crossover trial. Diabetes Metab Syndr Obes. 2024;17:4257-4265. doi:10.2147/DMSO.S468628.
8.
LyssenkoVAlmgrenPAnevskiD, et al. Predictors of and longitudinal changes in insulin sensitivity and secretion preceding onset of type 2 diabetes. Diabetes. 2005;54(1):166-174. doi:10.2337/diabetes.54.1.166.
9.
MitrakouAKelleyDMokanM, et al. Role of reduced suppression of glucose production and diminished early insulin release in impaired glucose tolerance. N Engl J Med. 1992;326(1):22-29.
10.
KitabchiAETemprosaMKnowlerWC, et al. Role of insulin secretion and sensitivity in the evolution of type 2 diabetes in the diabetes prevention program: effects of lifestyle intervention and metformin. Diabetes. 2005;54(8):2404-2414. doi:10.2337/diabetes.54.8.2404.
11.
KnowlerWCBarrett-ConnorEFowlerSE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403. doi:10.1056/NEJMoa012512.
12.
DeFronzoRATripathyDSchwenkeDC, et al. Pioglitazone for diabetes prevention in impaired glucose tolerance. N Engl J Med. 2011;364(12):1104-1115. doi:10.1056/NEJMoa1010949.
13.
le RouxCWAstrupAFujiokaK, et al. 3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial. Lancet Lond Engl. 2017;389(10077):1399-1409. doi:10.1016/S0140-6736(17)30069-7.
14.
KahnSEDeanfieldJEJeppesenOK, et al. Effect of semaglutide on regression and progression of glycemia in people with overweight or obesity but without diabetes in the SELECT trial. Diabetes Care. 2024;47(8):1350-1359. doi:10.2337/dc24-0491.
15.
JastreboffAMle RouxCWStefanskiA, et al. Tirzepatide for obesity treatment and diabetes prevention. N Engl J Med. 2025;392(10):958-971. doi:10.1056/NEJMoa2410819.
16.
UngerRHAguilar-ParadaEMüllerWAEisentrautAM. Studies of pancreatic alpha cell function in normal and diabetic subjects. J Clin Invest. 1970;49(4):837-848. doi:10.1172/JCI106297.
17.
SherwinRSFisherMHendlerRFeligP. Hyperglucagonemia and blood glucose regulation in normal, obese and diabetic subjects. N Engl J Med. 1976;294(9):455-461. doi:10.1056/NEJM197602262940901.
18.
NauckMAHeimesaatMMOrskovCHolstJJEbertRCreutzfeldtW. Preserved incretin activity of glucagon-like peptide 1 [7-36 amide] but not of synthetic human gastric inhibitory polypeptide in patients with type-2 diabetes mellitus. J Clin Invest. 1993;91(1):301-307. doi:10.1172/JCI116186.
19.
FlintAKapitzaCHindsbergerCZdravkovicM. The once-daily human glucagon-like peptide-1 (GLP-1) analog liraglutide improves postprandial glucose levels in type 2 diabetes patients. Adv Ther. 2011;28(3):213-226. doi:10.1007/s12325-010-0110-x.
20.
ScherbaumWA. The role of amylin in the physiology of glycemic control. Exp Clin Endocrinol Diabetes. 1998;106(2):97-102. doi:10.1055/s-0029-1211958.
21.
ThompsonRGGottliebAOrganKKodaJKisickiJKoltermanOG. Pramlintide: a human amylin analogue reduced postprandial plasma glucose, insulin, and C-peptide concentrations in patients with type 2 diabetes. Diabet Med. 1997;14(7):547-555. doi:10.1002/(SICI)1096-9136(199707)14:7%3C547::AID-DIA390%3E3.0.CO;2-U.
22.
HorowitzMEdelbroekMALWishartJMStraathofJW. Relationship between oral glucose tolerance and gastric emptying in normal healthy subjects. Diabetologia. 1993;36(9):857-862. doi:10.1007/bf00400362.
23.
JonesKLHorowitzMCarneyBIWishartJMGuhaSGreenL. Gastric emptying in early noninsulin-dependent diabetes mellitus. J Nucl Med. 1996;37(10):1643-1648.
24.
GonlachanvitSHsuCWBodenGH, et al. Effect of altering gastric emptying on postprandial plasma glucose concentrations following aphysiologic meal in type-II diabetic patients. Dig Dis Sci. 2003;48(3):488-497. doi:10.1023/a:1022528414264.
25.
MihaiBMMihaiCCijevschi-PrelipceanC, et al. Bidirectional relationship between gastric emptying and plasma glucose control in normoglycemic individuals and diabetic patients. J Diabetes Res. 2018;2018:1736959. doi:10.1155/2018/1736959.
26.
HorowitzMWuTRaynerCKMaratheCSJonesKL. Spontaneous or deliberate: effects of acute variations in glycemia on gastric emptying in type 1 diabetes. Diabetes Care. 2021;44(2):316-318. doi:10.2337/dci20-0067.
27.
MaJStevensJECukierK, et al. Effects of a protein preload on gastric emptying, glycemia, and gut hormones after a carbohydrate meal in diet-controlled type 2 diabetes. Diabetes Care. 2009;32(9):1600-1602. doi:10.2337/dc09-0723.
28.
GentilcoreDChaikominRJonesKL, et al. Effects of fat on gastric emptying of and the glycemic, insulin, and incretin responses to a carbohydrate meal in type 2 diabetes. J Clin Endocrinol Metab. 2006;91(6):2062-2067. doi:10.1210/jc.2005-2644.
29.
KamruzzamanMHorowitzMJonesKLMaratheCS. Gut-based strategies to reduce postprandial glycaemia in type 2 diabetes. Front Endocrinol (Lausanne). 2021;12:661877. doi:10.3389/fendo.2021.661877.
30.
ShuklaAPDickisonMCoughlinN, et al. The impact of food order on postprandial glycaemic excursions in prediabetes. Diabetes Obes Metab. 2019;21(2):377-381. doi:10.1111/dom.13503.
31.
GooRHMooreJGGreenbergEAlazrakiNP. Circadian variation in gastric emptying of meals in humans. Gastroenterology. 1987;93(3):515-518. doi:10.1016/0016-5085(87)90913-9.
32.
StengelATachéY. Neuroendocrine control of the gut during stress: corticotropin-releasing factor signaling pathways in the spotlight. Annu Rev Physiol. 2009;71:219-239. doi:10.1146/annurev.physiol.010908.163221.
33.
SekineANakajimaK. High blood glucose after starch loading in young women with small increase in salivary amylase: another crucial role of postprandial salivary amylase. J Clin Med Res. 2024;16(10):465-471. doi:10.14740/jocmr6057.
34.
AitaAGalozziPZeminF, et al. Salivary alpha-amylase: a marker of stress in gynecological residents during a shoulder dystocia simulation scenario. PLoS ONE. 2024;19(11):e0314234. doi:10.1371/journal.pone.0314234.
35.
DateKSatohAIidaKOgawaH. Pancreatic α-amylase controls glucose assimilation by duodenal retrieval through N-glycan-specific binding, endocytosis, and degradation. J Biol Chem. 2015;290(28):17439-17450. doi:10.1074/jbc.M114.594937.
36.
Pérez-RosPNavarro-FloresEJulián-RochinaIMartínez-ArnauFMCauliO. Changes in salivary amylase and glucose in diabetes: a scoping review. Diagn Basel Switz. 2021;11(3):453. doi:10.3390/diagnostics11030453.
37.
JenkinsDJWoleverTMTaylorRH, et al. Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr. 1981;34(3):362-366. doi:10.1093/ajcn/34.3.362.
38.
LiveseyGTaylorRHulshofTHowlettJ. Glycemic response and health—a systematic review and meta-analysis: relations between dietary glycemic properties and health outcomes. Am J Clin Nutr. 2008;87(1):258S-268S. doi:10.1093/ajcn/87.1.258s.
39.
HallHPerelmanDBreschiA, et al. Glucotypes reveal new patterns of glucose dysregulation. PLoS Biol. 2018;16(7):e2005143. doi:10.1371/journal.pbio.2005143.
40.
WuYEhlertBMetwallyAA, et al. Individual variations in glycemic responses to carbohydrates and underlying metabolic physiology. Nat Med. 2025;31(7):2232-2243. doi:10.1038/s41591-025-03719-2.
41.
BaoJAtkinsonFPetoczPWillettWCBrand-MillerJC. Prediction of postprandial glycemia and insulinemia in lean, young, healthy adults: glycemic load compared with carbohydrate content alone. Am J Clin Nutr. 2011;93(5):984-996. doi:10.3945/ajcn.110.005033.
42.
NauckMAMeierJJ. Incretin hormones: their role in health and disease. Diabetes Obes Metab. 2018;20 (suppl 1):5-21. doi:10.1111/dom.13129.
43.
Jakubowicz D, Barnea M, Wainstein J, Froy O. High caloric intake at breakfast vs. dinner differentially influences weight loss of overweight and obese women. Obesity (Silver Spring). 2013;21(12):2504-2512. doi:10.1002/oby.20460.
44.
SaitoYKajiyamaSNittaA, et al. Eating fast has a significant impact on glycemic excursion in healthy women: randomized controlled cross-over trial. Nutrients. 2020;12(9):2767. doi:10.3390/nu12092767.
45.
LiCJNorstedtGHuZG, et al. Effects of a macro-nutrient preload on type 2 diabetic patients. Front Endocrinol (Lausanne). 2015;6:139. doi:10.3389/fendo.2015.00139.
46.
ChiangSWLiuHWLohEW, et al. Whey protein supplementation improves postprandial glycemia in persons with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Nutr Res. 2022;104:44-54. doi:10.1016/j.nutres.2022.04.002.
47.
RussellJRYoungAWJorgensenNA. Effect of dietary corn starch intake on pancreatic amylase and intestinal maltase and pH in cattle. J Anim Sci. 1981;52(5):1177-1182. doi:10.2527/jas1981.5251177x.
48.
KdekianAAlssemaMVan Der BeekEM, et al. Impact of isocaloric exchanges of carbohydrate for fat on postprandial glucose, insulin, triglycerides, and free fatty acid responses-a systematic review and meta-analysis. Eur J Clin Nutr. 2020;74(1):1-8. doi:10.1038/s41430-019-0534-6.
49.
PostREMainousAG3rdKingDESimpsonKN. Dietary fiber for the treatment of type 2 diabetes mellitus: a meta-analysis. J Am Board Fam Med. 2012;25(1):16-23. doi:10.3122/jabfm.2012.01.110148.
50.
ShuklaAPAndonoJTouhamySH, et al. Carbohydrate-last meal pattern lowers postprandial glucose and insulin excursions in type 2 diabetes. BMJ Open Diabetes Res Care. 2017;5(1):e000440. doi:10.1136/bmjdrc-2017-000440.
51.
BelliniAScottodiPalumboANicolòABazzucchiISacchettiM. Exercise prescription for postprandial glycemic management. Nutrients. 2024;16(8):1170. doi:10.3390/nu16081170.
52.
KhalafiMSymondsMEGhasemiFRosenkranzSKRohaniHSakhaeiMH. The effects of exercise training on postprandial glycemia and insulinemia in adults with overweight or obesity and with cardiometabolic disorders: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2023;201:110741. doi:10.1016/j.diabres.2023.110741.
53.
HaxhiJScottodiPalumboASacchettiM. Exercising for metabolic control: is timing important?Ann Nutr Metab. 2013;62(1):14-25. doi:10.1159/000343788.
54.
BelliniANicolòABazzucchiISacchettiM. Effects of different exercise strategies to improve postprandial glycemia in healthy individuals. Med Sci Sports Exerc. 2021;53(7):1334-1344. doi:10.1249/mss.0000000000002607.
55.
AqeelMForsterARichardsE, et al. The effect of timing of exercise and eating on postprandial response in adults: a systematic review. Nutrients. 2020;12(1):221. doi:10.3390/nu12010221.
56.
ColbergSRZarrabiLBenningtonL, et al. Postprandial walking is better for lowering the glycemic effect of dinner than pre-dinner exercise in type 2 diabetic individuals. J Am Med Dir Assoc. 2009;10(6):394-397. doi:10.1016/j.jamda.2009.03.015.
57.
ZhangXZhengCHoRSTMiyashitaMWongSHS. The effects of accumulated versus continuous exercise on postprandial glycemia, insulin, and triglycerides in adults with or without diabetes: a systematic review and meta-analysis. Sports Med Open. 2022;8(1):14. doi:10.1186/s40798-021-00401-y.
58.
TsereteliNVallatRFernandez-TajesJ, et al. Impact of insufficient sleep on dysregulated blood glucose control under standardised meal conditions. Diabetologia. 2022;65(2):356-365. doi:10.1007/s00125-021-05608-y.
59.
StutzBKruegerBGoletzkeJ, et al. Glycemic response to meals with a high glycemic index differs between morning and evening: a randomized cross-over controlled trial among students with early or late chronotype. Eur J Nutr. 2024;63(5):1593-1604. doi:10.1007/s00394-024-03372-4.
60.
HerzogNJauch-CharaKHyzyF, et al. Selective slow wave sleep but not rapid eye movement sleep suppression impairs morning glucose tolerance in healthy men. Psychoneuroendocrinology. 2013;38(10):2075-2082. doi:10.1016/j.psyneuen.2013.03.018.
61.
StamatakisKAPunjabiNM. Effects of sleep fragmentation on glucose metabolism in normal subjects. Chest. 2010;137(1):95-101. doi:10.1378/chest.09-0791.
62.
TobaldiniEFiorelliEMSolbiatiMCostantinoGNobiliLMontanoN. Short sleep duration and cardiometabolic risk: from pathophysiology to clinical evidence. Nat Rev Cardiol. 2019;16(4):213-224. doi:10.1038/s41569-018-0109-6.
63.
ReutrakulSVan CauterE. Sleep influences on obesity, insulin resistance, and risk of type 2 diabetes. Metabolism. 2018;84:56-66. doi:10.1016/j.metabol.2018.02.010.
64.
ParkHMetwallyAADelfarahA, et al. High-resolution lifestyle profiling and metabolic subphenotypes of type 2 diabetes. NPJ Digit Med. 2025;8(1):352. doi:10.1038/s41746-025-01728-6.
65.
ChaputJPMcHillAWCoxRC, et al. The role of insufficient sleep and circadian misalignment in obesity. Nat Rev Endocrinol. 2023;19(2):82-97. doi:10.1038/s41574-022-00747-7.
66.
RuttersFNefsG. Sleep and circadian rhythm disturbances in diabetes: a narrative review. Diabetes Metab Syndr Obes. 2022;15:3627-3637. doi:10.2147/DMSO.S354026.
67.
SharmaALaurentiMCDalla ManC, et al. Glucose metabolism during rotational shift-work in healthcare workers. Diabetologia. 2017;60(8):1483-1490. doi:10.1007/s00125-017-4317-0.
68.
RakshitKThomasAPMatveyenkoAV. Does disruption of circadian rhythms contribute to beta-cell failure in type 2 diabetes. Curr Diab Rep. 2014;14(4):474. doi:10.1007/s11892-014-0474-4.
69.
TiwariRTamDNHShahJMoriyamaMVarneyJHuyNT. Effects of sleep intervention on glucose control: a narrative review of clinical evidence. Prim Care Diabetes. 2021;15(4):635-641. doi:10.1016/j.pcd.2021.04.003.
70.
García-SerranoCPujol SaludJAran-SoléL, et al. Enhancing night and day circadian contrast through sleep education in prediabetes and type 2 diabetes mellitus: a randomized controlled trial. Biology. 2022;11(6):893. doi:10.3390/biology11060893.
