Background: Since the publication of the Diabetes Control and Complications Trial results two decades ago, glycated haemoglobin (A1c) has remained the only validated measurement of glycemic control and marker for future complications. The growing use of continuous glucose monitoring (CGM) has opened a new era of measuring and following glycemia and it associated outcomes. These new available glucose variables can provide a broader insight to personalized glycemic control and provide valuable glucose measurements beyond A1c.
Objective and Hypotheses: Data from CGM enables to continuously record blood glucose levels, demonstrate glucose excursions, day to day and within day variability, provide a more accurate description of hypoglycemic and hyperglycemic episodes. Data driven by CGM can also overcome many of the limitations presented by A1c. For example; patients may have identical mean blood glucose but completely different levels of A1c. CGM reported glucose variables can be used for routine follow up of patients glycemia level, as well as a mean to assess the impact of new technologies and therapeutics on glycemic control. Thus, there is a need to define the various CGM glycemic variables with relation to outcomes, and to standardize the analysis and report of these variables. This will create a uniform basis for evaluation and comparison of the level of glycemia.
Method: Recently several consensus reports on CGM related glucose metrics have been composed by different groups of various opinion key leaders and experts in Type 1 Diabetes. These reports include the 2017 ATTD consensus recommendations, the join report of the American Diabetes Association and the European Association for the Study of Diabetes and other groups. The consensus recommendations define different and new categories for hypoglycemia, hyperglycemia, time with in different glucose ranges and glucose variability based on clinical evidence regarding CGM use. Furthermore, the different groups emphasize the value of hypoglycemia as an adjuvant measurement of glycemia in addition to time within range and A1c outcome.
Conclusion: The new era of technology and the use of CGM have provided important information on individual parameters to define and report the level of glycemia. CGM use has a positive impact on diabetes control and provides valuable andmeaningful information on the level of glycemia. Thus, efforts should be made to encourage its daily use for all patients with type 1 diabetes, and its glucose metrics as endpoints in clinical trials.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology