Division of Endocrinology and Metabolism, Department of Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Diabetes Metab J. 2020 Dec;44(6):828-839. doi: 10.4093/dmj.2020.0257. Epub 2020 Dec 23.
Glycosylated hemoglobin (HbA1c) has been the sole surrogate marker for assessing diabetic complications. However, consistently reported limitations of HbA1c are that it lacks detailed information on short-term glycemic control and can be easily interfered with by various clinical conditions such as anemia, pregnancy, or liver disease. Thus, HbA1c alone may not represent the real glycemic status of a patient. The advancement of continuous glucose monitoring (CGM) has enabled both patients and healthcare providers to monitor glucose trends for a whole single day, which is not possible with HbA1c. This has allowed for the development of core metrics such as time spent in time in range (TIR), hyperglycemia, or hypoglycemia, and glycemic variability. Among the 10 core metrics, TIR is reported to represent overall glycemic control better than HbA1c alone. Moreover, various evidence supports TIR as a predictive marker of diabetes complications as well as HbA1c, as the inverse relationship between HbA1c and TIR reveals. However, there are more complex relationships between HbA1c, TIR, and other CGM metrics. This article provides information about 10 core metrics with particular focus on TIR and the relationships between the CGM metrics for comprehensive understanding of glycemic status using CGM.
糖化血红蛋白(HbA1c)一直是评估糖尿病并发症的唯一替代标志物。然而,HbA1c 存在一些始终被报道的局限性,如它缺乏有关短期血糖控制的详细信息,并且容易受到各种临床情况(如贫血、妊娠或肝脏疾病)的干扰。因此,HbA1c 可能无法代表患者的真实血糖状态。连续血糖监测(CGM)的进步使患者和医疗保健提供者能够监测一整天的血糖趋势,而 HbA1c 则无法做到这一点。这使得能够开发出核心指标,如时间在目标范围内(TIR)、高血糖或低血糖以及血糖变异性。在 10 个核心指标中,据报道 TIR 比单独的 HbA1c 更能代表整体血糖控制情况。此外,各种证据支持 TIR 作为糖尿病并发症的预测标志物,就像 HbA1c 一样,因为 HbA1c 和 TIR 之间的反比关系揭示了这一点。然而,HbA1c、TIR 和其他 CGM 指标之间存在更复杂的关系。本文提供了有关 10 个核心指标的信息,特别关注 TIR 以及 CGM 指标之间的关系,以全面了解使用 CGM 的血糖状态。
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