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      Correlation between short- and mid-term hemoglobin A1c and glycemic control determined by continuous glucose monitoring

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          Abstract

          Background

          Glucose monitoring is vital for glycemic control in patients with diabetes mellitus (DM). Continuous glucose monitoring (CGM) measures whole-day glucose levels. Hemoglobin A1c (HbA1c) is a vital outcome predictor in patients with DM.

          Methods

          This study investigated the relationship between HbA1c and CGM, which remained unclear hitherto. Data of patients with DM (n = 91) who received CGM and HbA1c testing (1–3 months before and after CGM) were retrospectively analyzed. Diurnal and nocturnal glucose, highest CGM data (10%, 25%, and 50%), mean amplitude of glycemic excursions (MAGE), percent coefficient of variation (%CV), and continuous overlapping net glycemic action were compared with HbA1c values before and after CGM.

          Results

          The CGM results were significantly correlated with HbA1c values measured 1 (r = 0.69) and 2 (r = 0.39) months after CGM and 1 month (r = 0.35) before CGM. However, glucose levels recorded in CGM did not correlate with the HbA1c values 3 months after and 2–3 months before CGM. MAGE and %CV were strongly correlated with HbA1c values 1 and 2 months after CGM, respectively. Diurnal blood glucose levels were significantly correlated with HbA1c values 1–2 months before and 1 month after CGM. The nocturnal blood glucose levels were significantly correlated with HbA1c values 1–3 months before and 1–2 months after CGM.

          Conclusions

          CGM can predict HbA1c values within 1 month after CGM in patients with DM.

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          Most cited references40

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          The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus

          S Genuth, C. Siebert, D. M. Nathan … (1993)
          Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with insulin-dependent diabetes mellitus (IDDM). We examined whether intensive treatment with the goal of maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of these complications. A total of 1441 patients with IDDM--726 with no retinopathy at base line (the primary-prevention cohort) and 715 with mild retinopathy (the secondary-intervention cohort) were randomly assigned to intensive therapy administered either with an external insulin pump or by three or more daily insulin injections and guided by frequent blood glucose monitoring or to conventional therapy with one or two daily insulin injections. The patients were followed for a mean of 6.5 years, and the appearance and progression of retinopathy and other complications were assessed regularly. In the primary-prevention cohort, intensive therapy reduced the adjusted mean risk for the development of retinopathy by 76 percent (95 percent confidence interval, 62 to 85 percent), as compared with conventional therapy. In the secondary-intervention cohort, intensive therapy slowed the progression of retinopathy by 54 percent (95 percent confidence interval, 39 to 66 percent) and reduced the development of proliferative or severe nonproliferative retinopathy by 47 percent (95 percent confidence interval, 14 to 67 percent). In the two cohorts combined, intensive therapy reduced the occurrence of microalbuminuria (urinary albumin excretion of > or = 40 mg per 24 hours) by 39 percent (95 percent confidence interval, 21 to 52 percent), that of albuminuria (urinary albumin excretion of > or = 300 mg per 24 hours) by 54 percent (95 percent confidence interval 19 to 74 percent), and that of clinical neuropathy by 60 percent (95 percent confidence interval, 38 to 74 percent). The chief adverse event associated with intensive therapy was a two-to-threefold increase in severe hypoglycemia. Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.
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            Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)

            (1998)
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              Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study.

              I M Stratton, A. I. Adler, H. Neil … (2000)
              To determine the relation between exposure to glycaemia over time and the risk of macrovascular or microvascular complications in patients with type 2 diabetes. Prospective observational study. 23 hospital based clinics in England, Scotland, and Northern Ireland. 4585 white, Asian Indian, and Afro-Caribbean UKPDS patients, whether randomised or not to treatment, were included in analyses of incidence; of these, 3642 were included in analyses of relative risk. Primary predefined aggregate clinical outcomes: any end point or deaths related to diabetes and all cause mortality. Secondary aggregate outcomes: myocardial infarction, stroke, amputation (including death from peripheral vascular disease), and microvascular disease (predominantly retinal photo-coagulation). Single end points: non-fatal heart failure and cataract extraction. Risk reduction associated with a 1% reduction in updated mean HbA(1c) adjusted for possible confounders at diagnosis of diabetes. The incidence of clinical complications was significantly associated with glycaemia. Each 1% reduction in updated mean HbA(1c) was associated with reductions in risk of 21% for any end point related to diabetes (95% confidence interval 17% to 24%, P<0.0001), 21% for deaths related to diabetes (15% to 27%, P<0.0001), 14% for myocardial infarction (8% to 21%, P<0.0001), and 37% for microvascular complications (33% to 41%, P<0.0001). No threshold of risk was observed for any end point. In patients with type 2 diabetes the risk of diabetic complications was strongly associated with previous hyperglycaemia. Any reduction in HbA(1c) is likely to reduce the risk of complications, with the lowest risk being in those with HbA(1c) values in the normal range (<6.0%).
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                Author and article information

                Contributors
                Ting-I Lee:
                ORCID: http://orcid.org/0000-0002-4883-0199
                agleems29@gmail.com
                Journal
                Journal ID (nlm-ta): Diabetol Metab Syndr
                Journal ID (iso-abbrev): Diabetol Metab Syndr
                Title: Diabetology & Metabolic Syndrome
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1758-5996
                Publication date (Electronic): 6 September 2021
                Publication date PMC-release: 6 September 2021
                Publication date Collection: 2021
                Volume: 13
                Electronic Location Identifier: 94
                Affiliations
                [1 ]GRID grid.416930.9, ISNI 0000 0004 0639 4389, Division of Cardiovascular Medicine, Department of Internal Medicine, , Wan Fang Hospital, Taipei Medical University, ; Taipei, Taiwan
                [2 ]GRID grid.412896.0, ISNI 0000 0000 9337 0481, Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, , Taipei Medical University, ; Taipei, Taiwan
                [3 ]GRID grid.416930.9, ISNI 0000 0004 0639 4389, Cardiovascular Research Center, , Wan Fang Hospital, Taipei Medical University, ; Taipei, Taiwan
                [4 ]GRID grid.412896.0, ISNI 0000 0000 9337 0481, Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, , Taipei Medical University, ; 111 Xinglong Road, Section 3, Wenshan District, Taipei, 11696 Taiwan
                [5 ]GRID grid.416930.9, ISNI 0000 0004 0639 4389, Division of Endocrinology and Metabolism, Department of Internal Medicine, , Wan Fang Hospital, Taipei Medical University, ; Taipei, Taiwan
                [6 ]GRID grid.412896.0, ISNI 0000 0000 9337 0481, Department of General Medicine, School of Medicine, College of Medicine, , Taipei Medical University, ; Taipei, Taiwan
                [7 ]GRID grid.412896.0, ISNI 0000 0000 9337 0481, Graduate Institute of Clinical Medicine, , Taipei Medical University, ; Taipei, Taiwan
                Author information
                http://orcid.org/0000-0002-4883-0199
                Article
                Publisher ID: 714
                DOI: 10.1186/s13098-021-00714-8
                PMC ID: 8422722
                PubMed ID: 34488880
                SO-VID: 08e76fd4-1f7a-45c2-ab79-8baea832b81b
                Copyright © © The Author(s) 2021
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 24 June 2021
                Date accepted : 26 August 2021
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2021

                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: diabetes mellitus,continuous glucose monitoring,hemoglobin a1c
                Data availability:
                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: diabetes mellitus, continuous glucose monitoring, hemoglobin a1c

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