The Journal of Clinical Endocrinology and Metabolism Journal Article

Patients Who Benefit From CGM

November 01, 2022

Hidenori Yoshii, Tomoya Mita, Naoto Katakami, Yosuke Okada, Takeshi Osonoi, Katsumi Aso, Akira Kurozumi, Satomi Wakasugi, Fumiya Sato, Ryota Ishii, Masahiko Gosho, Iichiro Shimomura, Hirotaka Watada
The Journal of Clinical Endocrinology & Metabolism, Volume 107, Issue 10, October 2022, Pages e3990–e4003
https://doi.org/10.1210/clinem/dgac459

Abstract

Context

Current guidelines recommend assessing glycemic control using continuous glucose monitoring (CGM) and hemoglobin A1c (HbA1c) measurement.

Objective

This study aimed to clarify the characteristics of patients who might benefit from CGM metrics in addition to HbA1c monitoring.

Methods

CGM metrics, specifically time in range (TIR), time below range (TBR), and time above range (TAR), were determined in 999 outpatients with type 2 diabetes and compared between HbA1c categories (HbA1c < 53 mmol/mol [7.0%, HbA1c < ₅₃], HbA1c 53–63 mmol/mol [7.0–7.9%, HbA1c _53–63], HbA1c 64–74 mmol/mol [8.0–8.9%, HbA1c _64–74], and HbA1c ≥ 75 mmol/mol [9.0%, HbA1c ≥ ₇₅]) and between patients with identical HbA1c categories who were stratified by age, types of antidiabetic agents, and renal function.

Results

For HbA1c < ₅₃ category, patients aged ≥ 65 years had a significantly higher nocturnal TBR than those aged < 65 years. For HbA1c < ₅₃ and HbA1c _53–63 categories, patients receiving insulin and/or sulfonylureas had a significantly higher TAR and TBR, and a lower TIR than those not receiving these drugs, and for HbA1c _64–74 category, they had a significantly higher TBR. For HbA1c < ₅₃, HbA1c _53–63, and HbA1c _64–74 categories, patients with an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m² had a significantly higher TBR during some periods than those with an eGFR ≥ 60.

Conclusion

Higher HbA1c levels do not always protect against hypoglycemic episodes. Our data demonstrate that using CGM metrics to complement HbA1c monitoring is beneficial, especially in older people, users of insulin and/or sulfonylureas, and patients with chronic kidney disease.