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The Importance of Continuous Glucose Monitoring-derived Metrics Beyond HbA1c for Optimal Individualized Glycemic

Hidenori Yoshii1, Tomoya Mita2, Naoto Katakami3

  • 1Department of Medicine, Diabetology & Endocrinology, Juntendo Tokyo Koto Geriatric Medical Center, Koto-ku, Tokyo 136-0075, Japan.

The Journal of Clinical Endocrinology and Metabolism
|July 31, 2022
PubMed

Insights

Continuous glucose monitoring (CGM) metrics offer benefits beyond hemoglobin A1c (HbA1c) testing. CGM is particularly useful for older adults, those on insulin or sulfonylureas, and individuals with chronic kidney disease to monitor glucose levels.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Diabetes Management

Background:

  • Current guidelines recommend continuous glucose monitoring (CGM) and hemoglobin A1c (HbA1c) for assessing glycemic control.
  • However, the specific patient profiles that benefit most from CGM metrics alongside HbA1c are not fully elucidated.

Purpose of the Study:

  • To identify patient characteristics that indicate a greater benefit from utilizing CGM metrics in conjunction with HbA1c monitoring for type 2 diabetes management.

Main Methods:

  • The study analyzed CGM data (time in range (TIR), time below range (TBR), time above range (TAR)) from 999 outpatients with type 2 diabetes.
  • Data were compared across different HbA1c categories and stratified by age, antidiabetic agents, and estimated glomerular filtration rate (eGFR).

Main Results:

  • Older patients (≥65 years) with HbA1c < 53 mmol/mol had higher nocturnal TBR.
  • Patients on insulin/sulfonylureas showed altered TIR, higher TAR, and TBR across various HbA1c levels.
  • Patients with eGFR < 60 mL/min/1.73 m2 exhibited higher TBR in certain periods.

Conclusions:

  • Elevated HbA1c levels do not consistently prevent hypoglycemia.
  • CGM metrics provide valuable insights that complement HbA1c, especially for older individuals, those using specific medications, and patients with impaired renal function.
Abstract

Keywords:
continuous glucose monitoringglucose variabilityindividualization of glycemic controltime in range

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