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- Title
The Importance of Continuous Glucose Monitoringderived Metrics Beyond HbA1c for Optimal Individualized Glycemic Control.
- Authors
Hidenori Yoshii; Tomoya Mita; Naoto Katakami; Yosuke Okada; Takeshi Osonoi; Katsumi Aso; Akira Kurozumi; Satomi Wakasugi; Fumiya Sato; Ryota Ishii; Masahiko Gosho; Iichiro Shimomura; Hirotaka Watada
- Abstract
Context: Current guidelines recommend assessing glycemic control using continuous glucose monitoring (CGM) and hemoglobin A1c (HbA1c) measurement. Objective: This study aimed to clarify the characteristics of patients who might benefit from CGM metrics in addition to HbA1c monitoring. Methods: CGM metrics, specifically time in range (TIR), time below range (TBR), and time above range (TAR), were determined in 999 outpatients with type 2 diabetes and compared between HbA1c categories (HbA1c < 53 mmol/mol [7.0%, HbA1c <53], HbA1c 53-63 mmol/mol [7.0-7.9%, HbA1c 53-63], HbA1c 64-74 mmol/mol [8.0-8.9%, HbA1c64-74], and HbA1c = 75 mmol/mol [9.0%, HbA1c =75 ]) and between patients with identical HbA1c categories who were stratified by age, types of antidiabetic agents, and renal function. Results: For HbA1c<53 category, patients aged = 65 years had a significantly higher nocturnal TBR than those aged < 65 years. For HbA1c <53 and HbA1c53-63 categories, patients receiving insulin and/or sulfonylureas had a significantly higher TAR and TBR, and a lower TIR than those not receiving these drugs, and for HbA1c64-74 category, they had a significantly higher TBR. For HbA1c<53, HbA1c53-63, and HbA1c64-74 categories, patients with an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m² had a significantly higher TBR during some periods than those with an eGFR = 60. Conclusion: Higher HbA1c levels do not always protect against hypoglycemic episodes. Our data demonstrate that using CGM metrics to complement HbA1c monitoring is beneficial, especially in older people, users of insulin and/or sulfonylureas, and patients with chronic kidney disease.
- Subjects
GLYCEMIC control; BLOOD sugar monitoring; HEMOGLOBINS; OUTPATIENTS; HYPOGLYCEMIC agents
- Publication
Journal of Clinical Endocrinology & Metabolism, 2022, Vol 107, Issue 10, pe3990
- ISSN
0021-972X
- Publication type
Article
- DOI
10.1210/clinem/dgac459