Keywords
How to Cite
Abstract
Today, the problem of carbohydrate metabolism disorders is one of the most important in endocrinology, which helps to attract more resources from the world community to solve it. The review is devoted to highlighting and evaluating the latest indicators of blood glucose control, their interpretation and possibilities of use in practice. The role of continuous glucose monitoring (CGM) as a new method of glycemic control and its benefits is emphasized. By providing blood glucose measurements almost continuously for several days, the wearable minimally invasive glucose sensor has revolutionized the treatment of diabetes and is becoming an increasingly common technology, especially insulin-dependent patients. Round-the-clock monitoring of DM by a glucose monitoring system can predict and prevent hypo- or hyperglycemia. Time in range (TIR) is measured by CGM and should be used with other CGM indicators, including time below range (TBR), which indicates hypoglycemia, and time above range (TAR), which indicates hyperglycemia, as it is necessary to take into account not only the normal value TIR, but also the degree of deviation (TAR and TBR) from it. TIR has been shown to be inversely correlated with the risk of developing or progressing diabetes-related microvascular complications such as diabetic retinopathy, microalbuminuria, and peripheral neuropathy. The article also discusses the shortcomings of the most popular methods for assessing glycemia, in particular, by the level of glycated hemoglobin (HbA1c). This indicator does not reflect shortterm deviations of glycemia from the target values. In addition, the results of glycemic control with glycosylated hemoglobin may be impaired in pregnant women and patients with blood diseases. The relationship between CGM with HbA1c and mean blood glucose is shown: TIR and mean glucose are highly correlated with each other, but only moderately with HbA1c.
References
Khadanga S, Singh G, Pakhare AP, Joshi R. Diagnostic accuracy of point-of-care tests measuring glycosylated haemoglobin (HbA1c) for glycemic control: A field study in India. Cureus. 2021 Sep;13;13(9):e17920. doi:10.7759/cureus.17920.
Advani A. Positioning time in range in diabetes management. Diabetologia. 2020 Feb;63(2):242-52. doi: 10.1007/s00125-019-05027-0.
Runge AS, Kennedy L, Brown AS, Dove AE, Levine BJ, Koontz SP, et al. Does time-in-range matter? Perspectives from people with diabetes on the success of current therapies and the drivers of improved outcomes. Clin Diabetes. 2018 Apr;36(2):112-9. doi: 10.2337/cd17-0094.
Battelino T, Danne T, Bergenstal RM, Amiel SA, Beck R, Biester T, et al. Clinical targets for continuous glucose monitoring data interpretation: Recommendations from the International Consensus on Time in Range. Diabetes Care. 2019 Aug;42(8):1593-603. doi: 10.2337/dci19-0028.
Trial Research Group, Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, et al. Diabetes Control and Complications: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993 Sep;30;329(14):977-86. doi: 10.1056/NEJM199309303291401.
Ceriello A. The glucose triad and its role in comprehensive glycaemic control: current status, future management. Int J Clin Pract. 2010 Nov;64(12):1705-11. doi: 10.1111/j.1742-1241.2010.02517.x.
Klonoff DC. Hemoglobinopathies and hemoglobin A1c in diabetes mellitus. J Diabetes Sci Technol. 2020 Jan;14(1):3-7. doi: 10.1177/1932296819841698.
Younes ZMH, Abuali AM, Tabba S, Farooqi MH, Hassoun AAK. Prevalence of diabetes distress and depression and their association with glycemic control in adolescents with type 1 diabetes in Dubai, United Arab Emirates. Pediatr Diabetes. 2021 Jun;22(4):683-91. doi: 10.1111/pedi.13204.
Kalra S, Shaikh S, Priya G, Baruah MP, Verma A, Das AK, et al. Individualizing time-in-range goals in management of diabetes mellitus and role of insulin: clinical insights from a multinational panel. Diabetes Ther. 2021 Feb;12(2):465-85. doi: 10.1007/s13300-020-00973-0.
Beck RW, Bergenstal RM, Riddlesworth TD, Kollman C, Li Z, Brown AS, et al. Validation of time in range as an outcome measure for diabetes clinical trials. Diabetes Care. 2019 Mar;42(3):400-5. doi: 10.2337/dc18-1444.
Lu J, Ma X, Zhou J, Zhang L, Mo Y, Ying L, et al. Association of time in range, as assessed by continuous glucose monitoring, with diabetic retinopathy in type 2 diabetes. Diabetes Care. 2018 Nov;41(11):2370-6. doi: 10.2337/dc18-1131.
Feig DS, Donovan LE, Corcoy R, Murphy KE, Amiel SA, Hunt KF, et al. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet. 2017 Nov;25;390(10110):2347-59. doi: 10.1016/S0140-6736(17)32400-5.
Danne T, Nimri R, Battelino T, Bergenstal RM, Close KL, DeVries JH, et al. International consensus on use of continuous glucose monitoring. Diabetes Care. 2017 Dec;40(12):1631-40. doi: 10.2337/dc17-1600.
Dehghani Zahedani A, Shariat Torbaghan S, Rahili S, Karlin K, Scilley D, Thakkar R, et al. Improvement in glucose regulation using a digital tracker and continuous glucose monitoring in healthy adults and those with type 2 diabetes. Diabetes Ther. 2021 Jul;12(7):1871-86. doi: 10.1007/s13300-021-01081-3.
Mayeda L, Katz R, Ahmad I, Bansal N, Batacchi Z, Hirsch IB, et al. Glucose time in range and peripheral neuropathy in type 2 diabetes mellitus and chronic kidney disease. BMJ Open Diabetes Res Care. 2020 Jan;8(1):e000991. doi: 10.1136/bmjdrc-2019-000991.
Lu J, Ma X, Shen Y, Wu Q, Wang R, Zhang L, et al. Time in range is associated with carotid intima-media thickness in type 2 diabetes. Diabetes Technol Ther. 2020 Feb;22(2):72-8. doi: 10.1089/dia.2019.0251.
Lu J, Wang C, Shen Y, Chen L, Zhang L, Cai J, et al. Time in range in relation to all-cause and cardiovascular mortality in patients with type 2 diabetes: A Prospective Cohort Study. Diabetes Care. 2021 Feb;44(2):549-55. doi: 10.2337/dc20-1862.
Vigersky RA, McMahon C. The relationship of hemoglobin A1C to time-in-range in patients with diabetes. Diabetes Technol Ther. 2019 Feb;21(2):81-5. doi: 10.1089/dia.2018.0310.
Beyond A1C Writing Group. Need for regulatory change to incorporate beyond A1C glycemic metrics. Diabetes Care. 2018 Jun;41(6):e92–e94. doi: 10.2337/dci18-0010.
Murphy HR. Continuous glucose monitoring targets in type 1 diabetes pregnancy: every 5% time in range matters. Diabetologia. 2019 Jul;62(7):1123-8. doi: 10.1007/s00125-019-4904-3.
Hirsch IB. Glycemic variability and diabetes complications: Does it matter? Of course it does! Diabetes Care. 2015 Aug;38(8):1610- 4. doi: 10.2337/dc14-2898.
Peyser TA, Balo AK, Buckingham BA, Hirsch IB, Garcia A. Glycemic variability percentage: A novel method for assessing glycemic variability from continuous glucose monitor data. Diabetes Technol Ther. 2018 Jan;20(1):6-16. doi: 10.1089/ dia.2017.0187.
Kovatchev BP. Metrics for glycaemic control — from HbA1c to continuous glucose monitoring. Nat Rev Endocrinol. 2017 Jul;13(7):425-36. doi: 10.1038/nrendo.2017.3.
Sandig D, Grimsmann J, Reinauer C, Melmer A, Zimny S, Müller-Korbsch M, et al. Continuous glucose monitoring in adults with type 1 diabetes: Real-world data from the German/Austrian Prospective Diabetes Follow-Up Registry. Diabetes Technol Ther. 2020 Aug;22(8):602-12. doi: 10.1089/dia.2020.0019.
Rodrigues R, Rossi ICB, Rossi BF, Gomes DC, Penha-Silva N. New glycemic metrics and traditional clinical and laboratory profiles of children and adolescents with type 1 diabetes mellitus in an outpatient follow-up. Diabetes Res Clin Pract. 2021 Mar;173:108680. doi:10.1016/j.diabres.2021.108680.
American Diabetes Association. 6. Glycemic Targets: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021 Jan;44(Suppl 1):S73-S84. doi: 10.2337/dc21-S006.
Emerging Risk Factors Collaboration, Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010 Jun;26;375(9733):2215-22. doi: 10.1016/S0140-6736(10)60484-9.
Chehregosha H, Khamseh ME, Malek M, Hosseinpanah F, Ismail-Beigi F. A view beyond HbA1c: role of continuous glucose monitoring. Diabetes Ther. 2019 Jun;10(3):853-63. doi: 10.1007/ s13300-019-0619-1.
Hirakawa Y, Arima H, Zoungas S, Ninomiya T, Cooper M, Hamet P, et al. Impact of visit-to-visit glycemic variability on the risks of macrovascular and microvascular events and all-cause mortality in type 2 diabetes: The ADVANCE Trial. Diabetes Care. 2014 Aug;37(8):2359-65. doi: 10.2337/dc14-0199.
Borkowska A, Szymańska-Garbacz E, Kwiecińska E, Ignaczak A, Czupryniak L. Glucose variability and glycated hemoglobin HbA1c in type 1 and type 2 diabetes. Clinical Diabetology. 2017 Aug;6(2):48-56. doi: 10.5603/DK.2017.0009