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Glycaemic management in diabetes: old and new approaches

Antonio Ceriello1, Francesco Prattichizzo1, Moshe Phillip2

  • 1IRCCS MultiMedica, Milan, Italy.

The Lancet. Diabetes & Endocrinology
|November 18, 2021
PubMed

Insights

Glycaemic control in diabetes needs a holistic approach beyond HbA1c. Modern tools and therapies can help manage postprandial glucose, variability, and time in range while avoiding hypoglycemia.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Diabetes Management

Background:

  • Hemoglobin A1c (HbA1c) is the primary metric for assessing glycemic control in diabetes.
  • Emerging evidence indicates a need to consider multiple facets of hyperglycemia beyond HbA1c.
  • A paradigm shift is necessary for comprehensive diabetes management.

Purpose of the Study:

  • To advocate for a modern, multifaceted approach to glycemic control.
  • To emphasize the importance of reducing postprandial hyperglycemia and glycemic variability.
  • To highlight the goal of maximizing time in near-normoglycemic range while avoiding hypoglycemia.

Main Methods:

  • Review of current evidence on glycemic control parameters.
  • Discussion of technological advancements in glucose monitoring (e.g., continuous glucose monitoring).
  • Exploration of novel therapeutic agents (e.g., SGLT2 inhibitors, GLP-1 receptor agonists).

Main Results:

  • HbA1c alone provides an incomplete picture of glycemic control.
  • Reducing postprandial hyperglycemia and glycemic variability are crucial for optimal outcomes.
  • Continuous glucose monitoring and advanced therapies facilitate a more comprehensive management strategy.

Conclusions:

  • A holistic approach to glycemic control, integrating HbA1c with other parameters, is essential.
  • Technological innovations and new drug classes are transforming diabetes care.
  • The future of diabetes management lies in a personalized, multi-dimensional strategy beyond HbA1c targets.

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