6. Glycemic Targets: <i>Standards of Care in Diabetes—2023</i>

ElSayed, Nuha A.; Aleppo, Grazia; Aroda, Vanita R.; Bannuru, Raveendhara R.; Brown, F. C.; Bruemmer, Dennis; Collins, Billy; Hilliard, Marisa E.; Isaacs, Diana; Johnson, Eric L.; Kahan, Scott; Khunti, Kamlesh; León, José; Lyons, Sarah K.; Perry, Mary Lou; Prahalad, Priya; Pratley, Richard E.; Seley, Jane Jeffrie; Stanton, Robert C.; Gabbay, Robert A.

doi:10.2337/dc23-s006

Cited by 341 publications

(305 citation statements)

References 134 publications

Supporting

Mentioning

203

Contrasting

Unclassified

Order By: Relevance

“…Finally, while participants experienced large glycaemic improvement, mean HbA1c remained above 8%, mean TIR was 47%, and mean TAR was 51% by end of study, falling short of the standard recommended glycaemic targets (HbA1c <7%, TIR >70%, TAR <25%) 25 . This may be partly due to the very poor glycaemic control exhibited at baseline compared to other studies in which baseline HbA1c was below 9%, 5,26 or even below 8%, 27 and CGM metrics were closer to recommended guidelines at study onset 26,27 .…”

Section: Discussionmentioning

confidence: 90%

Assessing non‐adjunctive CGM safety at home and in new markets (ANSHIN)

Chao

Andrade

Bergford

et al. 2023

Endocrino Diabet & Metabol

View full text Add to dashboard Cite

Introduction Continuous glucose monitoring (CGM) can guide treatment for people with type 1 (T1D) and type 2 diabetes (T2D). The ANSHIN study assessed the impact of non‐adjunctive CGM use in adults with diabetes using intensive insulin therapy (IIT). Materials and Methods This single‐arm, prospective, interventional study enrolled adults with T1D or T2D who had not used CGM in the prior 6 months. Participants wore blinded CGMs (Dexcom G6) during a 20‐day run‐in phase, with treatment based on fingerstick glucose values, followed by a 16‐week intervention phase and then a randomized 12‐week extension phase with treatment based on CGM values. The primary outcome was change in HbA1c. Secondary outcomes were CGM metrics. Safety endpoints were the number of severe hypoglycaemic (SH) and diabetic ketoacidosis (DKA) events. Results Of the 77 adults enrolled, 63 completed the study. Those enrolled had mean (SD) baseline HbA1c of 9.8% (1.9%), 36% had T1D, and 44% were ≥65 years old. Mean HbA1c decreased by 1.3, 1.0 and 1.0 percentage points for participants with T1D, T2D or age ≥65, respectively (p < .001 for each). CGM‐based metrics including time in range also improved significantly. SH events decreased from the run‐in period (67.3 per 100 person‐years) to the intervention period (17.0 per 100 person‐years). Three DKA events unrelated to CGM use occurred during the total intervention period. Conclusions Non‐adjunctive use of the Dexcom G6 CGM system improved glycaemic control and was safe for adults using IIT.

show abstract

Section: Discussionmentioning

confidence: 90%

Assessing non‐adjunctive CGM safety at home and in new markets (ANSHIN)

Chao

Andrade

Bergford

et al. 2023

Endocrino Diabet & Metabol

View full text Add to dashboard Cite

show abstract

“…In the UKPDS (UK Prospective Diabetes Study), a 1% reduction in hemoglobin A1C was associated with a 16% risk reduction for the development of HF [ 20 ]. The glycemic target depends on the existence of comorbidity [ 26 ].…”

Section: Current Treatment Strategies For Heart Failure In Patients W...mentioning

confidence: 99%

Emerging Therapy for Diabetic Cardiomyopathy: From Molecular Mechanism to Clinical Practice

et al. 2023

View full text Add to dashboard Cite

Diabetic cardiomyopathy is characterized by abnormal myocardial structure or performance in the absence of coronary artery disease or significant valvular heart disease in patients with diabetes mellitus. The spectrum of diabetic cardiomyopathy ranges from subtle myocardial changes to myocardial fibrosis and diastolic function and finally to symptomatic heart failure. Except for sodium–glucose transport protein 2 inhibitors and possibly bariatric and metabolic surgery, there is currently no specific treatment for this distinct disease entity in patients with diabetes. The molecular mechanism of diabetic cardiomyopathy includes impaired nutrient-sensing signaling, dysregulated autophagy, impaired mitochondrial energetics, altered fuel utilization, oxidative stress and lipid peroxidation, advanced glycation end-products, inflammation, impaired calcium homeostasis, abnormal endothelial function and nitric oxide production, aberrant epidermal growth factor receptor signaling, the activation of the renin–angiotensin–aldosterone system and sympathetic hyperactivity, and extracellular matrix accumulation and fibrosis. Here, we summarize several important emerging treatments for diabetic cardiomyopathy targeting specific molecular mechanisms, with evidence from preclinical studies and clinical trials.

show abstract

“…MBG (mg/dL) � −137.5 + 41.66 × HbA1c (%) (Conversion formula MBG (mmol/l) � −2.7 + 0.212 × HbA1c (mmol/mol)). A1c-derived average glucose (ADAG) study data have been an often used reference for patients and providers for interpreting the relationship between HbA1c and MBG [18,22]. Data were collected from 11 centers in the US, Europe, Africa, and Asia.…”

Section: New Orleansmentioning

confidence: 99%

“…Te estimated Bayesian model is MBG � 27.85 + 17.11 * HbA1c (%), with Var(MBG| HbA1c) � 3074 * HbA1c 0.04 . Te 95% confdence intervals of MBG for diferent levels of HbA1c in Table 1 are based on the ftted Bayesian model to facilitate the comparison with the previously published data from the ADAG study [18,22].…”

Section: Analysis and Comparison Of Datamentioning

confidence: 99%

“…Guidelines have been published for the use of glycemic metrics in clinical practice for diabetes management in children [15][16][17][18]. In less-resourced areas of the world such as Africa, the use of self-monitored capillary glucose is prohibitively expensive and a point of care clinic HbA1c may be the main and sometimes the only metric for the assessment of glycemic control and for guiding insulin dosing [16].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Can HbA1c Alone Be Safely Used to Guide Insulin Therapy in African Youth with Type 1 Diabetes?

et al. 2023

View full text Add to dashboard Cite

Introduction. The relationship of HbA1c versus the mean blood glucose (MBG) is an important guide for diabetes management but may differ between ethnic groups. In Africa, the patient’s glucose information is limited or unavailable and the management is largely guided by HbA1c. We sought to determine if the reference data derived from the non-African populations led to an appropriate estimation of MBG from HbA1c for the East African patients. Methods. We examined the relationship of HbA1c versus MBG obtained by the continuous glucose monitoring in a group of East African youth having type 1 diabetes in Kenya and Uganda (n = 54) compared with the data obtained from A1c-derived average glucose (ADAG) and glucose management indicator (GMI) studies. A self-identified White (European heritage) population of youth (n = 89) with type 1 diabetes, 3–18 years old, living in New Orleans, LA, USA metropolitan area (NOLA), was studied using CGM as an additional reference. Results. The regression equation for the African cohort was MBG (mg/dL) = 32.0 + 16.73 × HbA1c (%), r = 0.55, p < 0.0001 . In general, the use of the non-African references considerably overestimated MBG from HbA1c for the East African population. For example, an HbA1c = 9% (74.9 mmol/mol) corresponded to an MBG = 183 mg/dL (10.1 mmol/L) in the East African group, but 212 mg/dL (11.7 mmol/L) using ADAG, 237 mg/dL (13.1 mmol/L) using GMI and 249 mg/dL (13.8 mmol/L) using NOLA reference. The reported occurrence of serious hypoglycemia among the African patients in the year prior to the study was 21%. A reference table of HbA1c versus MBG from the East African patients was generated. Conclusions. The use of non-African-derived reference data to estimate MBG from HbA1c generally led to the overestimation of MBG in the East African patients. This may put the East African and other African patients at higher risk for hypoglycemia when the management is primarily based on achieving target HbA1c in the absence of the corresponding glucose data.

show abstract

6. Glycemic Targets: Standards of Care in Diabetes—2023

Cited by 341 publications

References 134 publications

Assessing non‐adjunctive CGM safety at home and in new markets (ANSHIN)

Assessing non‐adjunctive CGM safety at home and in new markets (ANSHIN)

Emerging Therapy for Diabetic Cardiomyopathy: From Molecular Mechanism to Clinical Practice

Can HbA1c Alone Be Safely Used to Guide Insulin Therapy in African Youth with Type 1 Diabetes?

Contact Info

Product

Resources

About