Metrics for glycaemic control - from HbA1c to continuous glucose monitoring
Abstract
As intensive treatment to lower levels of HbA 1c characteristically results in an increased risk of hypoglycaemia, patients with diabetes mellitus face a life-long optimization problem to reduce average levels of glycaemia and postprandial hyperglycaemia while simultaneously avoiding hypoglycaemia. This optimization can only be achieved in the context of lowering glucose variability. In this Review, I discuss topics that are related to the assessment, quantification and optimal control of glucose fluctuations in diabetes mellitus. I focus on markers of average glycaemia and the utility and/or shortcomings of HbA 1c as a 'gold-standard' metric of glycaemic control; the notion that glucose variability is characterized by two principal dimensions, amplitude and time; measures of glucose variability that are based on either self-monitoring of blood glucose data or continuous glucose monitoring (CGM); and the control of average glycaemia and glucose variability through the use of pharmacological agents or closed-loop control systems commonly referred to as the 'artificial pancreas'. I conclude that HbA 1c and the various available metrics of glucose variability reflect the management of diabetes mellitus on different timescales, ranging from months (for HbA 1c) to minutes (for CGM). Comprehensive assessment of the dynamics of glycaemic fluctuations is therefore crucial for providing accurate and complete information to the patient, physician, automated decision-support or artificial-pancreas system.
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The distribution of time outside the target glucose range is asymmetrical.
“Importantly, the distribution of time outside the target range is asymmetrical (31).”
From Time in Range in Relation to All-Cause and Cardiovascular Mortality in Patients With Type 2 Diabetes: A Prospective Cohort Study (2021) · cites this paper as [31]
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- Authors
- Kovatchev, B. P.
- Affiliations
- University of Virginia (US)
- Corresponding author
- Kovatchev, Boris P.
- ORCID
- Kovatchev, Boris P.
- Venue
- Nature Reviews Endocrinology
- Published
- 2017-03-17
- Volume
- 13
- Issue
- 7
- Pages
- 425-436
- ISSN
- 1759-5029 (ISSN-L)
- 1759-5037
- OpenAlex
- W2596063051
- Cited by
- 272
- References
- 124
- Citations by year
- 2026: 26 · 2025: 22 · 2024: 28 · 2023: 33 · 2022: 42 · 2021: 34 · 2020: 30 · 2019: 28 · 2018: 21 · 2017: 8
- FWCI
- 3.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sanofi
- Dexcom
- National Institutes of Health (5r01dk051562-23)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01-DK-051562)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- glycemic control, HbA1c, glycemic variability, continuous glucose monitoring, diabetes mellitus, hypoglycemia, postprandial hyperglycemia, self-monitoring of blood glucose, artificial pancreas, feedback control
- MeSH terms
- Algorithms, Blood Glucose, Diabetes Mellitus, Glycated Hemoglobin, Humans, Blood Glucose Self-Monitoring, Biomarkers
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