Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, USA.
Department of Medicine, Division of Endocrinology, Loyola University Health Care System, Maywood, IL, USA.
J Diabetes Complications. 2020 Aug;34(8):107585. doi: 10.1016/j.jdiacomp.2020.107585. Epub 2020 Apr 23.
Intensive glycemic control minimizes the risks of microvascular complications in diabetes. A1C is a convenient estimate of mean blood glucose, but is not the only marker available. The practical use and limitations of alternative markers and continuous glucose monitors are the focus of this review.
PubMed and the Cochrane Library were searched for studies concerning applications or limitations of A1C, fructosamine, glycated albumin, 1,5-anhydroglucitol, skin autofluorescence, and continuous glucose monitoring. Papers reporting on strengths, limitations, or comparisons of these methods were reviewed for inclusion.
A1C reflects three months of glycemic control and is not an ideal marker in all patient populations. Fructosamine and glycated albumin reflect mean blood glucose over three weeks. 1,5-Anhydroglucitol can measure hyperglycemic excursions in days to weeks. Continuous glucose monitors provide immediate feedback for timely intervention to reduce glycemic excursions and can assess glycemic variability. Current barriers to continuous glucose monitor use include inexperience, cost, discomfort, and medication interference.
Many promising alternative glycemic markers exist. The main limitations for all alternative methods of glycemic monitoring are a lack of standardization for clinically useful cut-offs or guidelines, and a lack of long-term data on their association with complications, particularly in varied patient populations.
强化血糖控制可最大限度降低糖尿病微血管并发症的风险。糖化血红蛋白（A1C）是评估平均血糖的便捷指标，但并非唯一可用的标志物。本综述重点关注其他替代标志物和连续血糖监测仪的实际应用和局限性。
通过 PubMed 和 Cochrane 图书馆检索有关 A1C、果糖胺、糖化白蛋白、1,5-脱水葡萄糖醇、皮肤自发荧光和连续血糖监测的应用或局限性的研究。综述了报告这些方法的优缺点或比较的论文，以纳入分析。
A1C 反映了三个月的血糖控制情况，但并非所有患者群体的理想标志物。果糖胺和糖化白蛋白反映了三周内的平均血糖水平。1,5-脱水葡萄糖醇可测量数天至数周的高血糖波动。连续血糖监测仪可提供即时反馈，以便及时进行干预以降低血糖波动，并可评估血糖变异性。连续血糖监测仪使用的当前障碍包括经验不足、成本、不适和药物干扰。
存在许多有前途的替代血糖标志物。所有替代血糖监测方法的主要局限性在于缺乏用于临床的有用切点或指南的标准化，以及缺乏长期数据来证明其与并发症的关联，特别是在不同患者群体中。
