Symposium 15: The new metrics, how to use them to improve control
DOI:
https://doi.org/10.47196/diab.v56i3Sup.585Keywords:
diabetes mellitus, metricsAbstract
HbA1c is traditionally considered the gold standard metric of long-term glycemic control in subjects with Type 1 Diabetes (T1D) and DCCT has shown its relation with microvascular complications . However, in recent years, increasing evidence outlined the several limitations of HbA1, its measurement does not provide direct information abouthypoglycemia, glycemic excursions and, thus, glycaemic variability. It may also be influenced by several physiological factors and medical conditions that affect hemoglobin glycation and red blood cell life span.Finally, it has become clear that the clinical utility of HbA1c in guiding diabetes managementis strongly and mainly related to the assessment of the risk of chronic diabetes complications and not to the day-by-day management of T1D.
Continuous glucose monitoring (CGM) has extended as an important tool to improve glycemic outcomes in youth with type 1 diabetes, despite the fact that in our country there is a wide gap regarding technology, mostly due to restrictions in coverage for CGM by public and some privateinsurance. The development of CGM technology has allowed for more frequent glucose measurements with less burden on the individual with diabetes and caregivers. Now CGM is recommended for children and adolescents with intensive insulin therapy (ADA, ISPAD).
References
I. Piona C, Marigliano M, Mozzillo E, et al. Relationships between HbA1c and continuous glucose monitoring metrics of glycaemic control and glucose variability in a large cohort of children and adolescents with type 1 diabetes. Diabetes Research and Clinical Practice 2021;177,108933
II. Battelino T, Danne T, Bergenstal R, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the International Consensus on Time in Range. Diabetes Care 2019;42:1593-1603.
III. Addala A, Zaharieva DP, et al. Clinically serious hypoglycemia is rare and not associated with time-in-range in youth with new-onset type 1 diabetes. The Journal of Clinical Endocrinology & Metabolism 2021;106 (11):3239-3247.
IV. Prahalad P, Ding V, Zaharieva D, Addala A, Johari R, Scheinker D, Desai M, Hood K, Maahs D. Team work, targets, technology, and tight control in newly diagnosed type 1 diabetes: the Pilot 4T. The Journal of Clinical Endocrinology & Metabolism 2022;107 (4): 998-1008.
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