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Revisiting the Relationships Between Measures of Glycemic Control and Hypoglycemia in Continuous Glucose Monitoring

Marga Gimenez1,2, Amitai Jeremy Tannen2, Monika Reddy2

  • 1Diabetes Unit, Endocrinology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain.

Diabetes Care
|December 2, 2017
PubMed

Insights

The relationship between HbA1c and hypoglycemia in type 1 diabetes follows a J-shaped curve, with risks increasing at lower HbA1c levels. Continuous glucose monitoring (CGM) may alter this association.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Diabetes Management

Background:

  • The Diabetes Control and Complications Trial (DCCT) previously established an inverse correlation between HbA1c and severe hypoglycemia.
  • Understanding this relationship is crucial for optimizing glycemic control in type 1 diabetes.

Purpose of the Study:

  • To investigate the association between hypoglycemia and HbA1c in a large type 1 diabetes cohort using blinded continuous glucose monitoring (CGM) data.
  • To assess the impact of real-time CGM on these relationships and variations based on biochemical hypoglycemia definitions.

Main Methods:

  • Utilized blinded CGM data from the JDRF CGM randomized control trial.
  • Calculated percentage of time spent below various hypoglycemia thresholds (3.9, 3.3, 3.0, 2.8 mmol/L) and employed quadratic regression.
  • Analyzed relationships visually and used ANOVA to assess glycemia and time below threshold.

Main Results:

  • Observed J-shaped relationships between HbA1c and hypoglycemia across all biochemical thresholds.
  • Lowest hypoglycemia risk was found at HbA1c levels of 8.1–8.6% (65–70 mmol/mol).
  • Utilizing CGM for an average of 5 days/week flattened these relationships, particularly for thresholds below 3.3 mmol/L, with ANOVA confirming a lost association at 3.3 mmol/L.

Conclusions:

  • The association between hypoglycemia and HbA1c in type 1 diabetes is J-shaped.
  • Lower HbA1c levels remain linked to increased hypoglycemia risk, with the magnitude influenced by the biochemical definition of hypoglycemia.
  • Real-time CGM use may decrease time spent in hypoglycemia, thereby modifying the HbA1c-hypoglycemia relationship.
Abstract

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