Beyond HbA1c: A CGM-centred three-pillar framework for glycaemic variability in pre-diabetes and type 2 diabetes.
Level 5 - mechanism / opinion, no new human data
Narrative review and perspective framework with no new empirical data
PubMed 42357829 · doi:10.1111/dme.70404
What was done
This perspective and narrative review synthesized evidence from prospective cohorts, mechanistic studies, randomized controlled trials, and real-world data to propose a continuous glucose monitoring (CGM)-centered three-pillar management framework for glycemic variability across the pre-diabetes and type 2 diabetes continuum.
What was found
The abstract reports no primary quantitative data or pooled statistical effect sizes. It notes that glycemic variability contributes to beta-cell dysfunction and cardiovascular risk, and that CGM-guided interventions can improve time in range, reduce glycemic variability and hypoglycemia, and support clinical remission (defined as HbA1c <48 mmol/mol [<6.5%] without medication for ≥3 months).
Why it matters
It advocates shifting pre-diabetes and type 2 diabetes care from static HbA1c-focused targets toward dynamic, continuous monitoring of glycemic fluctuations.
Limits
This is a narrative framework without original human data or systematic pooling. Long-term outcomes in pre-diabetes, cost-effectiveness, and global accessibility of CGM remain unmeasured.
Cited by
- supports Constant glucose spikes and crashes contribute to metabolic dysfunction and over time can progress to pre-diabetes.