Glycaemic management in diabetes: old and new approaches

Ceriello, A. et al | 2021 | Glycaemic management in diabetes: old and new approaches | The Lancet Diabetes & Endocrinology | DOI:https://doi.org/10.1016/S2213-8587(21)00245-X

Summary

HbA_1c is the most used parameter to assess glycaemic control. However, evidence suggests that the concept of hyperglycaemia has profoundly changed and that different facets of hyperglycaemia must be considered. A modern approach to glycaemic control should focus not only on reaching and maintaining optimal HbA_1c concentrations as early as possible, but to also do so by reducing postprandial hyperglycaemia, glycaemic variability, and to extend as much as possible the time in range in near-normoglycaemia. These goals should be achieved while avoiding hypoglycaemia, which, should it occur, should be reverted to normoglycaemia. Modern technology, such as intermittently scanned glucose monitoring and continuous glucose monitoring, together with new drug therapies (eg, ultra-fast insulins, SGLT2 inhibitors, and GLP-1 receptor agonists), could help to change the landscape of glycaemia management based on HbA_1c in favour of a more holistic approach that considers all the different aspects of this commonly oversimplified pathophysiological feature of diabetes.

Glycaemic management in diabetes: old and new approaches [abstract only]

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Glycaemic control during the lockdown for COVID-19 in adults with type 1 diabetes #Covid19RftLks

Garofolo, M. et al | 2021| Glycaemic control during the lockdown for COVID-19 in adults with type 1 diabetes: A meta-analysis of observational studies | Diabetes Research and Clinical Practice | doi: https://doi.org/10.1016/j.diabres.
2021.109066

This review is available online ahead of print. It updates an earlier systematic systematic review and meta-analysis of studies assessing the effects of lockdown during COVID-19 pandemic on glucose metrics in adult subjects
with type 1 diabetes using continuous glucose monitoring (CGM) and flash glucose monitoring (FGM).

The reviewers report that in their meta-analysis of aggregate data shows that well-controlled people with type 1
diabetes on both MDI and CSII with continuous or flash glucose monitoring did not experience a 14 deterioration in glucose control throughout the COVID-19 lockdown, showing a modest, though statistically significant improvement in many glucose control parameters (Garofolo et al, 2021).

Abstract

Aims:

To assess the effects of lockdown due to COVID-19 pandemic on glucose metrics, measured by glucose monitoring systems, in adult individuals with type 1 diabetes.

Methods: We conducted a systematic literature search for English language articles from MEDLINE, Scopus and Web of Science up to February 28, 2021, using “diabetes”, “lockdown”, and “glucose” as key search terms. Time in range (TIR) was the main outcome; other metrics were time above range (TAR), time below range (TBR), mean blood glucose (MBG) and its variability ( per cent CV), estimated HbA1c (eA1c) or glucose management indicator (GMI).

Results: Seventeen studies for a total of 3,441 individuals with type 1 diabetes were included in the analysis. In the lockdown period, TIR 70-180 mg/dl increased by 3.05 per cent declined by 3.39 per cent (-5.14 to -1.63 per cent ) and 1.96 per cent (-2.51 to -1.42 per cent ), respectively (p less than 0.0001 for both). Both TBR less than 70 and less than 54 mg/dL remained unchanged. MBG slightly decreased by 5.40 mg/dL (-7.29 to – 3.51 mg/dL; p less than 0.0001) along with a reduction in per centCV. Pooled eA1c and GMI decreased by 0.18 per cent (-0.24 to -0.11 per cent ; p less than 0.0001) and a similar reduction was observed when GMI alone was considered (0.15 per cent, -0.23 to – 0.07 per cent; p less than 0.0001). Sensor use was only slightly but not significantly reduced during lockdown.

Conclusions: This meta-analysis shows that well-controlled people with type 1 diabetes on both MDI and CSII with continuous or flash glucose monitoring did not experience a deterioration in glucose control throughout the COVID-19 lockdown, showing a modest, though statistically significant improvement in many glucose control parameters.

Glycaemic control during the lockdown for COVID-19 in adults with type 1 diabetes: A meta-analysis of observational studies [paper ahead of print]

Type 2 diabetes: maintain glycaemic control to prevent complications

Guidelines in Practice| October 2020| Type 2 diabetes: maintain glycaemic control to prevent complications

This article provides an overview of the following:

• the simplified approach to cardiovascular risk stratification in the Primary Care Diabetes Europe position statement
• early initiation of effective treatment to prevent worsening of complications
• pharmacological treatment options for patients with type 2 diabetes and co-morbidities.

CVD is one of the most prevalent co-morbidities causally associated with type 2 diabetes and is the primary reason for mortality in these patients. Early combination therapy is advocated in this guidance to minimise the risk of CVD and other complications in patients with type 2 diabetes.

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