The importance of HbA1c and glucose variability in patients with type 1 and type 2 diabetes: outcome of continuous glucose monitoring (CGM)
Abstract
Glucose variability has recently been investigated in diabetic patients in several studies, but most of them considered only a few variability indicators and did not systematically correlate them with patients' HbA1c levels and other important characteristics. In thus study, the correlations between HbA1c levels and metabolic control (average glucose, AG), glucose variability (SD, CONGA, MAGE, MODD, BG ROC), hyperglycemia (HBGI), hypoglycemia (LBGI) and postprandial (AUC PP) indices were investigated in patients with type 1 and type 2 diabetes. The study involved 68 patients divided into 3 groups as follows: 35 patients had type 1 diabetes (group 1); 17 had type 2 diabetes and were taking multiple daily injections (MDI) of insulin (group 2); and 16 patients had type 2 diabetes treated with OHA and/or basal insulin (group 3). The indicators were obtained over at least 48 h using a continuous glucose monitoring (CGM) system. HbA1c levels were measured at the baseline and after CGM. HbA1c correlated significantly with AG (r = 0.74), AUC PP (r = 0.69) and HBGI (r = 0.74), but only in type 1 diabetic patients. Patients with longstanding disease and type 1 diabetes had a greater glucose variability, irrespective of their HbA1c levels. Insulin therapy with MDI correlated strongly with HbA1c, but not with glucose variability. HbA1c levels identify states of sustained hyperglycemia and seem to be unaffected by hypoglycemic episodes or short-lived glucose spikes, consequently revealing shortcomings as a "gold standard" indicator of metabolic control. Glucose variability indicators describe the glucose profile of type 1 diabetic patients and identify any worsening glycemic control (typical of longstanding diabetes) more accurately than HbA1c tests.
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Fluctuations in blood glucose levels may contribute more to outcomes than constant high blood glucose concentrations.
“Other studies have demonstrated that fluctuations in blood glucose levels may contribute more to outcomes than constant high blood glucose concentrations.31–35”
From Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen (2020) · cites this paper as [35]
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- Authors
- Sartore, G., Chilelli, N. C., Burlina, S., Stefano, P. D., Piarulli, F., Fedele, D., Mosca, A., & Lapolla, A.
- Affiliations
- University of Padua (IT)
- Medtronic (Italy) (IT)
- University of Milan (IT)
- Corresponding author
- Chilelli, Nino Cristiano
- ORCID
- Venue
- Acta Diabetologica
- Published
- 2012-04-01
- Volume
- 49
- Issue
- S1
- Pages
- 153-160
- ISSN
- 0940-5429 (ISSN-L)
- 1432-5233
- OpenAlex
- W2010300451
- Cited by
- 90
- References
- 35
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 3 · 2023: 1 · 2022: 1 · 2021: 9 · 2020: 10 · 2019: 9 · 2018: 3 · 2017: 5 · 2016: 2 · 2015: 13 · 2014: 5 · 2013: 8 · 2012: 6
- FWCI
- 8.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Acta Diabetologica (publishedVersion)
- PubMed (publishedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- HbA1c, glycemic variability, type 1 diabetes, type 2 diabetes, continuous glucose monitoring, glycemic control, multiple daily insulin injections, basal insulin, oral antidiabetic drugs, hypoglycemia, hyperglycemia, postprandial blood glucose, disease duration
- MeSH terms
- Adult, Aged, Blood Glucose, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Insulin, Male, Middle Aged, Treatment Outcome, Drug Monitoring, Young Adult
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