Utility of different glycemic control metrics for optimizing management of diabetes  

作　　者：Klaus-Dieter Kohnert Peter Heinke Lutz Vogt Eckhard Salzsieder 

机构地区：[1]Institute of Diabetes "Gerhardt Katsch" [2]Diabetes Service Center

出　　处：《World Journal of Diabetes》2015年第1期17-29,共13页世界糖尿病杂志（英文版）（电子版）

摘　　要：The benchmark for assessing quality of long-term glycemic control and adjustment of therapy is currently glycated hemoglobin(Hb A1c). Despite its importance as an indicator for the development of diabeticcomplications, recent studies have revealed that this metric has some limitations; it conveys a rather complex message, which has to be taken into consideration for diabetes screening and treatment. On the basis of recent clinical trials, the relationship between Hb A1 c and cardiovascular outcomes in long-standing diabetes has been called into question. It becomes obvious that other surrogate and biomarkers are needed to better predict cardiovascular diabetes complications and assess efficiency of therapy. Glycated albumin, fructosamin, and 1,5-anhydroglucitol have received growing interest as alternative markers of glycemic control. In addition to measures of hyperglycemia, advanced glucose monitoring methods became available. An indispensible adjunct to Hb A1 c in routine diabetes care is selfmonitoring of blood glucose. This monitoring method is now widely used, as it provides immediate feedback to patients on short-term changes, involving fasting, preprandial, and postprandial glucose levels. Beyond the traditional metrics, glycemic variability has been identified as a predictor of hypoglycemia, and it might also be implicated in the pathogenesis of vascular diabetes complications. Assessment of glycemic variability is thus important, but exact quantification requires frequently sampled glucose measurements. In order to optimize diabetes treatment, there is a need for both key metrics of glycemic control on a day-to-day basis and for more advanced, user-friendly monitoring methods. In addition to traditional discontinuous glucose testing, continuous glucose sensing has become a useful tool to reveal insufficient glycemic management. This new technology is particularly effective in patients with complicated diabetes and provides the opportunity to characterize glucose dynamics. Several continuous glucose moniThe benchmark for assessing quality of long-termglycemic control and adjustment of therapy is currentlyglycated hemoglobin （HbA1c）. Despite its importanceas an indicator for the development of diabeticcomplications, recent studies have revealed that thismetric has some limitations; it conveys a rather complexmessage, which has to be taken into considerationfor diabetes screening and treatment. On the basis ofrecent clinical trials, the relationship between HbA1cand cardiovascular outcomes in long-standing diabeteshas been called into question. It becomes obvious thatother surrogate and biomarkers are needed to betterpredict cardiovascular diabetes complications and assessefficiency of therapy. Glycated albumin, fructosamin,and 1,5-anhydroglucitol have received growing interestas alternative markers of glycemic control. In additionto measures of hyperglycemia, advanced glucosemonitoring methods became available. An indispensibleadjunct to HbA1c in routine diabetes care is selfmonitoringof blood glucose. This monitoring methodis now widely used, as it provides immediate feedbackto patients on short-term changes, involving fasting,preprandial, and postprandial glucose levels. Beyondthe traditional metrics, glycemic variability has beenidentified as a predictor of hypoglycemia, and it mightalso be implicated in the pathogenesis of vasculardiabetes complications. Assessment of glycemicvariability is thus important, but exact quantificationrequires frequently sampled glucose measurements. Inorder to optimize diabetes treatment, there is a needfor both key metrics of glycemic control on a day-to-daybasis and for more advanced, user-friendly monitoringmethods. In addition to traditional discontinuous glucosetesting, continuous glucose sensing has become auseful tool to reveal insufficient glycemic management.This new technology is particularly effective in patientswith complicated diabetes and provides the opportunityto characterize glucose dynamics. Several continuousglucose monitoring （CGM） systems, which have

关 键 词：MARKERS of glycemic control HemoglobinA1c POSTPRANDIAL GLUCOSE Risk of HYPERGLYCEMIA andhypoglycemia Continuous GLUCOSE monitoring Glycemicvariability GLUCOSE dynamics STANDARDIZATION DIABETESMELLITUS 

分 类 号：R587.1[医药卫生—内分泌]