Beyond HbA<sub>1c</sub>: using continuous glucose monitoring metrics to enhance interpretation of treatment effect and improve clinical decision‐making

Brown, Sue A.; Basu, Ananda; Kovatchev, Boris

doi:10.1111/dme.13944

Cited by 21 publications

(20 citation statements)

References 30 publications

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“…HbA1c changes slowly and reflects averages over months, whereas CGM reflects actual excursions in minutes. Brown et al pointed CGM reviewed several clinical scenarios of glycaemic outcomes from CGM data that can be analyzed to describe glycaemic variability and its attendant risks of hyperglycaemia and hypoglycaemia, to enhance interpretation of treatment effect and improve clinical decision-making 34 . In our further research, we will explore the changes of these parameters which from CGM with different levels of HbA1c.…”

Section: Discussionmentioning

confidence: 99%

A new approach for investigating the relative contribution of basal glucose and postprandial glucose to HbA1C

Yang

et al. 2021

Nutr. Diabetes

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To develop an accurate method for evaluating the relative contributions of basal glucose (BG) and postprandial glucose (PPG) to glycated haemoglobin (HbA1c) in subjects with hyperglycaemia using a Continuous Glucose Monitoring System (CGMS®). The subjects were divided into the normal glucose tolerance (NGT), impaired glucose tolerance (IGT), newly-diagnosed type 2 diabetes (NDDM), and drug-treated type 2 diabetes (T2DM) groups. We evaluated the relative contributions of BG and PPG to HbA1c in patients with hyperglycaemia according to three different baseline values. Subjects (n = 490) were grouped as follows: 92 NGT, 36 IGT, 131 NDDM, and 231 T2DM. The relative contributions of PPG to HbA1c were calculated using baseline values of 6.1 mmol/L, 5.6 mmol/L, and the 24-h glucose curve of the NGT group. The relative contribution of PPG to HbA1c decreased progressively from the IGT group to the T2DM group. Compared with the 24-h glucose curve as the baseline, the relative contribution of PPG was overestimated in 9.04% and 1.76% of the subjects when 6.1 mmol/L and 5.6 mmol/L were used as baselines, respectively (P < 0.01), in T2DM patients. The 24-h glucose curve of NGT is more suitable for studying the relative contributions of BG and PPG to HbA1c and it is more precise, as it considers physiological fluctuations in NGT after meals. However, 5.6 mmol/L can be used when the 24-h glucose curve for NGT is unavailable; using 6.1 mmol/L as a baseline value may overestimate the contribution to the HbA1c. There is no unified standard for assessing the contributions of basal glucose (BG) and postprandial glucose (PPG) to HbA1c. The 24-h glucose curve of NGT is more suitable for studying the relative contributions of BG and PPG to HbA1c, as it considers physiological fluctuations in NGT after meals. However, 5.6 mmol/L can be used when the 24-h glucose curve for NGT is unavailable; using 6.1 mmol/L as a baseline value may overestimate the contribution to the HbA1c.

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Section: Discussionmentioning

confidence: 99%

A new approach for investigating the relative contribution of basal glucose and postprandial glucose to HbA1C

Yang

et al. 2021

Nutr. Diabetes

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“…The increasing availability of CGM devices has produced a greater focus on the assessment of indices of glucose control different from HbA1c, such as glucose variability and time in range; however, such variables cannot be used for the assessment of the effect of either CGM or FGM in comparison with SMBG, as measurements of glucose in the treatment arms are not comparable. The only possible way to perform such an analysis would be the use of a blinded CGM device in the SMBG group.…”

Section: Discussionmentioning

confidence: 99%

Section: T a B L E 1 Effects Of Continuous Subcutaneous Insulin Infusmentioning

confidence: 99%

Impact of technology on glycaemic control in type 2 diabetes: A meta‐analysis of randomized trials on continuous glucose monitoring and continuous subcutaneous insulin infusion

Dicembrini

Mannucci

Monami

et al. 2019

Diabetes Obesity Metabolism

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Aim To conduct a meta‐analysis to assess the effect of continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), and the combination of the two, on glycaemic control in type 2 diabetes. Materials and methods The analysis included randomized clinical trials comparing CSII with multiple daily injections (MDI) in people with type 2 diabetes, as well as studies comparing CGM or flash glucose monitoring (FGM) with self‐monitoring of blood glucose (SMBG), with a duration of at least 12 weeks, identified in Medline or http://clinicaltrials.gov. The principal endpoint was glycated haemoglobin (HbA1c) at the end of the trial. Mean and 95% confidence intervals (CIs) for HbA1c and Mantel–Haenzel odds ratios for severe hypoglycaemia were calculated, using random‐effect models. Results The retrieved trials showed a significant heterogeneity (I2 = 90%). The difference in HbA1c between CSII and MDI was not statistically significant (−0.26% [95% CI –0.74;0.22]; P = .29). The difference in endpoint HbA1c between CGM and SMBG was marginally significant (−0.24 [95% CI –0.49;0.00]; P = .05), and CGM was possibly associated with a lower hypoglycaemic risk. Only one trial explored the effect of FGM, as compared with SMBG, on HbA1c in type 2 diabetes, finding no difference across groups (at study end: 8.4% ± 0.8% vs 8.3% ± 1.1% with FGM and SMBG, respectively). Conversely, FGM was associated with an improvement in quality of life and with a lower incidence of hypoglycaemic events. The small number of retrieved trials indicates that the results should be interpreted with caution. Conclusions The analysis showed that CSII, CGM and FGM provide only small benefits compared with MDI (on either HbA1c, hypoglycaemic risk or quality of life) in insulin‐treated people with type 2 diabetes.

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“…Literature on the impact of FlashGM on glycaemic parameters other than HbA 1c is lacking. However, there is an increasing body of evidence that supports the use of additional glycaemic metrics (10,(36)(37)(38). HbA 1c values are skewed in conditions such as pregnancy, anaemia and haemoglobinopathies (26).…”

Section: Comparison To Other Studiesmentioning

confidence: 99%

Efficacy of Flash Glucose Monitoring in Type 1 and Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Liang

Koye

Hachem

et al. 2022

Front. Clin. Diabetes Healthc.

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ObjectiveFlash glucose monitoring (FlashGM) is a sensor-based technology that displays glucose readings and trends to people with diabetes. In this meta-analysis, we assessed the effect of FlashGM on glycaemic outcomes including HbA1c, time in range, frequency of hypoglycaemic episodes and time in hypo/hyperglycaemia compared to self-monitoring of blood glucose, using data from randomised controlled trials.MethodsA systematic search was conducted on MEDLINE, EMBASE and CENTRAL for articles published between 2014 and 2021. We selected randomised controlled trials comparing flash glucose monitoring to self-monitoring of blood glucose that reported change in HbA1c and at least one other glycaemic outcome in adults with type 1 or type 2 diabetes. Two independent reviewers extracted data from each study using a piloted form. Meta-analyses using a random-effects model was conducted to obtain a pooled estimate of the treatment effect. Heterogeneity was assessed using forest plots and the I2 statistic.ResultsWe identified 5 randomised controlled trials lasting 10 – 24 weeks and involving 719 participants. Flash glucose monitoring did not lead to a significant reduction in HbA1c. However, it resulted in increased time in range (mean difference 1.16 hr, 95% CI 0.13 to 2.19, I2 = 71.7%) and decreased frequency of hypoglycaemic episodes (mean difference -0.28 episodes per 24 hours, 95% CI -0.53 to -0.04, I2 = 71.4%).ConclusionsFlash glucose monitoring did not lead to a significant reduction in HbA1c compared to self-monitoring of blood glucose, however, it improved glycaemic management through increased time in range and decreased frequency of hypoglycaemic episodes.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier PROSPERO (CRD42020165688).

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Beyond HbA_1c: using continuous glucose monitoring metrics to enhance interpretation of treatment effect and improve clinical decision‐making

Cited by 21 publications

References 30 publications

A new approach for investigating the relative contribution of basal glucose and postprandial glucose to HbA1C

A new approach for investigating the relative contribution of basal glucose and postprandial glucose to HbA1C

Impact of technology on glycaemic control in type 2 diabetes: A meta‐analysis of randomized trials on continuous glucose monitoring and continuous subcutaneous insulin infusion

Efficacy of Flash Glucose Monitoring in Type 1 and Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

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Beyond HbA1c: using continuous glucose monitoring metrics to enhance interpretation of treatment effect and improve clinical decision‐making

Cited by 21 publications

References 30 publications

A new approach for investigating the relative contribution of basal glucose and postprandial glucose to HbA1C

A new approach for investigating the relative contribution of basal glucose and postprandial glucose to HbA1C

Impact of technology on glycaemic control in type 2 diabetes: A meta‐analysis of randomized trials on continuous glucose monitoring and continuous subcutaneous insulin infusion

Efficacy of Flash Glucose Monitoring in Type 1 and Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

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Beyond HbA_1c: using continuous glucose monitoring metrics to enhance interpretation of treatment effect and improve clinical decision‐making