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Beyond HbA1c: A CGM-centred three-pillar framework for glycaemic variability in pre-diabetes and type 2 diabetes

Taoming Qian1, Donghao Guo2, Meijun Zhang3

  • 1Graduate School, Heilongjiang University of Chinese Medicine, Harbin, China.

Diabetic Medicine : a Journal of the British Diabetic Association
|June 26, 2026
PubMed

Insights

Glycaemic variability (GV) management using continuous glucose monitoring (CGM) offers a new approach for type 2 diabetes and pre-diabetes. This precision-guided care improves outcomes and supports remission.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Diabetes Management

Background:

  • Traditional type 2 diabetes mellitus (T2DM) management focuses on HbA1c, overlooking glycaemic variability (GV).
  • GV independently drives complications like β-cell dysfunction and cardiovascular risk, even in pre-diabetes.
  • Existing reviews often focus narrowly on T2DM or HbA1c-centric strategies.

Purpose of the Study:

  • To present a unified, three-pillar closed-loop framework for managing glycaemic stability.
  • To integrate continuous glucose monitoring (CGM) across the pre-diabetes to remission continuum.
  • To highlight GV as a modifiable therapeutic target.

Main Methods:

  • Synthesis of evidence from prospective cohorts, mechanistic studies, and randomized controlled trials.
  • Analysis of real-world data on CGM-guided interventions.
  • Development of a three-pillar framework: tiered personalized targets, data-driven decision support, and patient-clinician collaboration.

Main Results:

  • Glycaemic variability (GV) is a modifiable therapeutic target.
  • CGM reveals dynamic glucose patterns missed by HbA1c.
  • Interventions improve time in range (TIR), reduce GV and hypoglycemia, and aid clinical remission.

Conclusions:

  • CGM-centered management represents a paradigm shift towards dynamic, precision-guided care.
  • The proposed framework offers a structured roadmap for managing glycaemic stability.
  • Future research should focus on long-term outcomes, cost-effectiveness, and global accessibility.
Abstract

Keywords:
HbA1ccontinuous glucose monitoringglycaemic variabilitypre‐diabetestype 2 diabetes

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