Affiliations: [a] Cattedra di Medicina Interna, Seconda Facoltà di Medicina e Chirurgia, Università degli Studi di Napoli, Piazza L. Miraglia, 2, 80138 Naples, Italy. e-mail: firstname.lastname@example.org
Abstract: A condition of insulin resistance (IR) frequently occurs in the elderly. This is because of some age-related hormonal and metabolic changes, which are responsible for increased serum levels of fasting blood glucose. IR also induces an increased and prolonged serum value of post-prandial hyperglycaemia, favouring the atherosclerotic process and frequent acute cardiovascular events. This review examines how the post-prandial hyperglycaemic “spikes” play a major role in vascular damage in aged individuals with or without diabetes mellitus. This occurs through oxidative stress, endothelial dysfunction and subclinical inflammation induced by IR, as illustrated by numerous experiments and clinical reports. The evidence opposing all this is from two major trials, the STOP-NIDDM study and the recent HEART2D study. Finally, it is hypothesised that a daily dose of acarbose may prevent or mitigate this damage in aged people without overt diabetes mellitus.