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Complications of diabetes and metrics of glycaemic management derived from continuous glucose monitoring
Journal article   Open access   Peer reviewed

Complications of diabetes and metrics of glycaemic management derived from continuous glucose monitoring

Michael Yapanis, Steven James, Maria E Craig, David O'Neal and Elif I Ekinci
Journal of Clinical Endocrinology and Metabolism, Vol.107(6), pp.2221-2236
2022
DOI: https://doi.org/10.1210/clinem/dgac034
PMCID: PMC9113815
PMID: 35094087
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Published Version Open Access CC BY V4.0
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https://doi.org/10.1210/clinem/dgac034View
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Abstract

Continuous glucose monitoring Glycaemic variability Type 2 diabetes mellitus Diabetes complications Time-in-range Type 1 diabetes mellitus
Context: Although HbA1c is currently the best parameter used clinically to assess risk for the development of diabetes complications, it does not provide insight into short-term fluctuations in glucose levels. This review summarises the relationship between continuous glucose monitoring (CGM)-derived metrics of glycaemic variability and diabetes-related complications. Evidence acquisition: Pubmed and Embase databases were searched from 1 st January 2010 to 22 nd August 2020, using terms: type 1 diabetes, type 2 diabetes, diabetes-related micro- and macrovascular complications, measures of glycaemic variability. Exclusion criteria were studies that did not use CGM and studies involving participants who were: not diabetic, acutely unwell (post-stroke, post-surgery), pregnant or utilising insulin pumps. Evidence synthesis: 1,636 records were identified, and 1,602 were excluded, leaving 34 publications in the final review. Of the 20,852 total participants, 663 had type 1 diabetes and 19,909 had type 2 diabetes. Glycaemic variability and low time-in-range (TIR) showed associations with all studied microvascular and macrovascular complications of diabetes. Notably, higher TIR associated with reduced risk of albuminuria, retinopathy, cardiovascular disease mortality, all-cause mortality, and abnormal carotid intima-media thickness (CIMT). Peripheral neuropathy was predominantly associated with standard deviation (SD) and mean amplitude of glycaemic excursions (MAGE). Conclusions: The evidence supports the association between diabetes complications and CGM-derived measures of intra-day glycaemic variability. TIR emerged as the most consistent measure, supporting its emerging role in clinical practice. More longitudinal studies and trials are required to confirm these associations, particularly for type 1 diabetes where there are limited data.

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