Is avoidance of hypoglycaemia a better target than HbA1C in older people with diabetes?

摘要

In this commentary, the authors put forward a case for greater use of continuous glucose monitoring (CGM) in older people with diabetes to aid deprescribing and avoidance of hypoglycaemia rather than using HbA1c targets. Diabetes mellitus is a complex chronic illness often accompanied by multiple co-morbidities and polypharmacy in the older person. Worldwide, there are about 425 million people living with diabetes, of whom approximately 123 million are aged between 65 to 99 years. The aim of diabetes management is to achieve optimum glycaemic control, in order to prevent long-term microvascular, macrovascular and neurological complications. Glycated haemoglobin (HbA1C) is currently the key surrogate marker for long-term diabetes control and complications. However, HbA1C depicts only a single estimate of average glucose over the last 2–3 months and fails to give information on glucose fluctuations or variability in the patient's daily life. An established method of capturing glucose levels on a day to day basis is via finger-prick testing (self-monitoring of blood glucose [SMBG]). However, a Cochrane review reported that SMBG did not provide consistent long-term improvements in glycaemic control for non-insulin users with Type 2 diabetes.