Age and Red Blood Cell Parameters Mainly Explain the Differences Between HbA1c and Glycemic Management Indicator Among Patients With Type 1 Diabetes Using Intermittent Continuous Glucose Monitoring.

IF 4.1 Q2 ENDOCRINOLOGY & METABOLISM Journal of Diabetes Science and Technology Pub Date : 2024-11-01 Epub Date: 2023-08-11 DOI:10.1177/19322968231191544
Pablo Azcoitia, Raquel Rodríguez-Castellano, Pedro Saavedra, María P Alberiche, Dunia Marrero, Ana M Wägner, Antonio Ojeda, Mauro Boronat
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Abstract

Background: Glycated hemoglobin (HbA1c) is the gold standard to assess glycemic control in patients with diabetes. Glucose management indicator (GMI), a metric generated by continuous glucose monitoring (CGM), has been proposed as an alternative to HbA1c, but the two values may differ, complicating clinical decision-making. This study aimed to identify the factors that may explain the discrepancy between them.

Methods: Subjects were patients with type 1 diabetes, with one or more HbA1c measurements after starting the use of the Freestyle Libre 2 intermittent CGM, who shared their data with the center on the Libreview platform. The 14-day glucometric reports were retrieved, with the end date coinciding with the date of each HbA1c measurement, and those with sensor use ≥70% were selected. Clinical data prior to the start of CGM use, glucometric data from each report, and other simultaneous laboratory measurements with HbA1c were collected.

Results: A total of 646 HbA1c values and their corresponding glucometric reports were obtained from 339 patients. The absolute difference between HbA1c and GMI was <0.3% in only 38.7% of cases. Univariate analysis showed that the HbA1c-GMI value was associated with age, diabetes duration, estimated glomerular filtration rate, mean corpuscular volume (MCV), red cell distribution width (RDW), and time with glucose between 180 and 250 mg/dL. In a multilevel model, only age and RDW, positively, and MCV, negatively, were correlated to HbA1c-GMI.

Conclusion: The difference between HbA1c and GMI is clinically relevant in a high percentage of cases. Age and easily accessible hematological parameters (MCV and RDW) can help to interpret these differences.

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年龄和红细胞参数是使用间歇性连续血糖监测的 1 型糖尿病患者 HbA1c 和血糖管理指标差异的主要原因。
背景:糖化血红蛋白(HbA1c糖化血红蛋白(HbA1c)是评估糖尿病患者血糖控制情况的黄金标准。葡萄糖管理指标(GMI)是由连续血糖监测仪(CGM)生成的一种指标,已被提议作为 HbA1c 的替代指标,但这两个值可能存在差异,从而使临床决策变得复杂。本研究旨在找出可能导致两者差异的因素:研究对象为 1 型糖尿病患者,他们在开始使用 Freestyle Libre 2 间歇式 CGM 后进行了一次或多次 HbA1c 测量,并在 Libreview 平台上与中心共享数据。我们检索了 14 天的血糖报告,其结束日期与每次 HbA1c 测量的日期一致,并选择了传感器使用率≥ 70% 的患者。收集了开始使用 CGM 之前的临床数据、每份报告中的血糖测量数据以及其他与 HbA1c 同时进行的实验室测量数据:结果:共获得 339 名患者的 646 个 HbA1c 值及其相应的血糖报告。HbA1c 和 GMI 之间的绝对差值为 结论:HbA1c 和 GMI 之间的差值为 0.5%:在很大比例的病例中,HbA1c 和 GMI 之间的差异与临床相关。年龄和易于获得的血液学参数(MCV 和 RDW)有助于解释这些差异。
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来源期刊
Journal of Diabetes Science and Technology
Journal of Diabetes Science and Technology Medicine-Internal Medicine
CiteScore
7.50
自引率
12.00%
发文量
148
期刊介绍: The Journal of Diabetes Science and Technology (JDST) is a bi-monthly, peer-reviewed scientific journal published by the Diabetes Technology Society. JDST covers scientific and clinical aspects of diabetes technology including glucose monitoring, insulin and metabolic peptide delivery, the artificial pancreas, digital health, precision medicine, social media, cybersecurity, software for modeling, physiologic monitoring, technology for managing obesity, and diagnostic tests of glycation. The journal also covers the development and use of mobile applications and wireless communication, as well as bioengineered tools such as MEMS, new biomaterials, and nanotechnology to develop new sensors. Articles in JDST cover both basic research and clinical applications of technologies being developed to help people with diabetes.
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