Utility of different glycemic control metrics for optimizingmanagement of diabetes

The 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