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ADC-01834 Ver 2.0 11/15
This site is intended for healthcare professionals only.
THIS SITE IS INTENDED FOR HCPs ONLY.
THIS SITE IS INTENDED FOR HCPs ONLY.

The critical need for a more comprehensive view of glucose patterns

As the existing standard for assessing the quality of diabetes treatment, the HbA1c has proven to be a reliable tool. As a measure of glucose exposure over a period of 3 months, HbA1c does not help to identify critically important daily glucose patterns.1,2

Patients may experience various periods of high and low glucose levels throughout the day. This glucose variability may be occurring regardless of HbA1c value. For example, a patient that attains an HbA1c value within their target goal of 7% may experience significant glucose fluctuations.1

HbA1c Measurement with the Ambulatory Glucose Profile Chart 1

Evaluating glucose control

Considered in combination with HbA1c, glucose variability may be a more reliable indicator of glucose control—and the risk for long-term complications—than mean HbA1c alone2:

  • Increased glucose variability is a strong predictor of hypoglycemia and is correlated with poor glycemic control1
    • Severe hypoglycemia is linked to excessive morbidity and mortality1
    • Persistent glucose excursions are associated with oxidative stress, which plays a significant role in the pathogenesis of diabetic complications1,2
  • Glucose variability is predictive of patient satisfaction with an intensive insulin regimen1

Analyzing glucose variability

Self-monitored blood glucose (SMBG) may show more patterns of glucose variability than HbA1c alone—however, the episodic nature of SMBG means that significant incidents of hypoglycemia and hyperglycemia are often overlooked.1 For SMBG to adequately show a true representation of glucose variability, it would take 7 to 10 capillary glucose measurements per day.3

Continuous glucose monitoring (CGM) can reveal significant hypoglycemia, particularly overnight, or hyperglycemic excursions after meals that are missed with SMBG.1 CGM is associated with a significant lowering of HbA1c and reduction in hypoglycemic events.4 Patients who wear CGM sensors have been shown to have lower HbA1c levels than patients who use SMBG.5

Along with the data from CGM, the ambulatory glucose profile (AGP) can make HbA1c even more useful to clinical management. The AGP provides a way to track glucose variability by showing how closely the glucose readings of an individual patient fall within target range.1 For example, the detection of patterns or trends with AGP, such as recurrent hypoglycemia at a consistent time during the day, could reveal a need to change treatment or patient lifestyle decisions.1

Different patients with the same or similar HbA1c values can have markedly different rates of high and low glucose levels throughout the day and overnight, as well as different rates of hypoglycemia1,2

HbA1c Measurement with the Ambulatory Glucose Profile Chart 2 HbA1c Measurement with the Ambulatory Glucose Profile Chart 3

The detection of patterns or trends, such as recurrent hypoglycemia at a consistent time during the day, could reveal a need to change treatment or patient lifestyle decisions.1

References: 1. Bergenstal RM, Ahmann AJ, Bailey T, et al. Recommendations for standardizing glucose reporting and analysis to optimize clinical decision making in diabetes: the ambulatory glucose profile. J Diabetes Sci Technol. 2013;7:562-578. 2. Kohnert KD, Vogt L, Salzsieder E. Advances in understanding glucose variability and the role of continuous glucose monitoring. Eur Endocrinol. 2010;6:53-56. 3. Mazze RS. Making sense of glucose monitoring technologies: from SMBG to CGM. Diabetes Technol Ther. 2005:7:784-787. 4. Battelino T, Phillip M, Bratina N, Nimri R, Oskarsson P, Bolinder J. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes Care. 2011;34:795-800. 5. Langendam M, Luijf YM, Hooft L, DeVries JH, Mudde AH, Scholten RJPM. Continuous glucose monitoring systems for type 1 diabetes mellitus. Cochrane Database Syst Rev. 2012;1.

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