Relationship between Clinical Markers of Glycemia and Glucose Excursion Evaluated by Continuous Glucose Monitoring (CGM).

Abstract

Abstract. in order to evaluate the relationship between clinical markers of glycemia and glucose excursion, we performed 48-hour continuous glucose monitoring (Cgm) in 43 diabetic patients. For the clinical markers, hba1c, glycoalbumin (ga), and 1,5-anhydroglucitol (1,5-ag) were measured, and for the parameters of glucose excursion from Cgm, average glucose (ag), standard deviation of glucose (SD), the area under the curve for glucose levels >180 mg/dL (auC>180), and the difference between the maximum and minimum glucose levels during 48 hours (ΔG48hr) were analyzed. all patients were treated without any changes of the dosages of oral anti-diabetic agents or insulin for at least the previous 6 months with coefficient of variation (CV) of HbA1c less than 4 %. in results, while hba1c did not show any single correlation with ag, SD, auC>180, or ΔG48hr, both GA and 1,5-AG were significantly related to all these parameters. Furthermore, GA significantly correlated to all CGM parameters, and SD significantly correlated to GA in multiple regression analyses. These results suggest that ga may be a different marker from hba1c for diabetic complications, because ga, but not hba1c, may reflect not only short-term average glucose but also fluctuation of glucose.Key words: glycoalbumin, glycated hemoglobin, 1,5-anhydroglucitol, Continuous glucose monitoringThe sTAble frAcTion of glycated hemoglobin (hba 1c ) is routinely measured in the majority of patients with diabetes around the world, since hba 1c reflects the mean glucose level over the preceding 3 months [1]. hba 1c is not only used to determine whether a patient's metabolic control has been maintained within the target range, but also to estimate the risk of chronic diabetic complications in each patient. Previous the large-scale prospective studies of diabetic patients have used hba 1c as a marker of glycemic control to evaluate the association of consistent hyperglycemia with the development or progression of chronic diabetic complications [2,3]. however, recent studies have indicated that postprandial hyperglycemia or fluctuations of the glucose level may be an independent risk factor for macrovascular complications in diabetic patients, which cannot be evaluated by measuring hba 1c alone [4]. Since hba 1c is a marker of the average level of glycemia, it does not reflect acute glucose fluctuations and is poorly correlated with glucose excursions [5]. Therefore, in order to assess the risk of diabetic complications, especially macrovascular complications, it may be necessary to evaluate not only the mean level of glycemic control, but also the extent of glucose excursions such as glucose fluctuations or postprandial elevation of glucose.To assess daily blood glucose excursions, portable devices for self-monitoring of blood glucose (Smbg) are now widely used by insulin-treated diabetic patients. although such devices are helpful, the number of measuring times is limited. Recently, a continuous subcutaneous glucose monitoring (Cgm) device was developed to evaluate the...

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“…35 However, the exact reasons why FA and GA are related to daily glycemic excursions remain unclear. 36 FA assays are cheap and fast and can be performed in routine laboratories; however, they are currently underutilized. 37 Some studies have reviewed the usefulness of FA.…”