Department of Medicine, Diabetology & Endocrinology, Juntendo Tokyo Koto Geriatric Medical Center, Koto-ku, Tokyo 136-0075, Japan.
Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan.
J Clin Endocrinol Metab. 2022 Sep 28;107(10):e3990-e4003. doi: 10.1210/clinem/dgac459.
Current guidelines recommend assessing glycemic control using continuous glucose monitoring (CGM) and hemoglobin A1c (HbA1c) measurement.
This study aimed to clarify the characteristics of patients who might benefit from CGM metrics in addition to HbA1c monitoring.
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%, HbA1c 64-74], 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.
For HbA1c < 53 category, patients aged ≥ 65 years had a significantly higher nocturnal TBR than those aged < 65 years. For HbA1c < 53 and HbA1c 53-63 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 HbA1c 64-74 category, they had a significantly higher TBR. For HbA1c < 53, HbA1c 53-63, and HbA1c 64-74 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.
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.
目前的指南建议使用连续血糖监测（CGM）和糖化血红蛋白（HbA1c）测量来评估血糖控制情况。
本研究旨在阐明除了 HbA1c 监测之外，哪些患者可能从 CGM 指标中获益。
在 999 名 2 型糖尿病门诊患者中确定了 CGM 指标，具体为血糖达标时间（TIR）、血糖低于目标范围时间（TBR）和血糖高于目标范围时间（TAR），并将其与 HbA1c 分类（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%，HbA1c 64-74]和 HbA1c≥75 mmol/mol[9.0%，HbA1c≥75]）以及相同 HbA1c 分类的患者进行比较，这些患者根据年龄、抗糖尿病药物类型和肾功能进行分层。
对于 HbA1c＜53 分类，年龄≥65 岁的患者夜间 TBR 明显高于年龄＜65 岁的患者。对于 HbA1c＜53 和 HbA1c 53-63 分类，接受胰岛素和/或磺脲类药物治疗的患者 TAR 和 TBR 明显更高，TIR 明显更低，而对于 HbA1c 64-74 分类，TBR 明显更高。对于 HbA1c＜53、HbA1c 53-63 和 HbA1c 64-74 分类，估算肾小球滤过率（eGFR）＜60 mL/min/1.73 m2的患者在某些时间段的 TBR 明显高于 eGFR≥60 的患者。
较高的 HbA1c 水平并不总是能预防低血糖发作。我们的数据表明，使用 CGM 指标来补充 HbA1c 监测是有益的，特别是在老年人、使用胰岛素和/或磺脲类药物的患者以及患有慢性肾脏病的患者中。
