623-P: Should We Continue Using HbA1c for Treatment Adjustment in Patients with Type 2 Diabetes?

Abstract

According current guidelines, treatment decision in patients with type 2 diabetes is based on HbA1c, reflecting approximately recent three months control. But there are many data showing that HbA1c is an insufficient control assessment tool omitting to present glucose fluctuations and variability. Continuous glucose monitoring (CGM) is used for insulin dose adjustment but is rarely used in type 2 diabetes patient treatment determination. In our study we compare the results derived from non-real time CGM and HbA1c to find out which could be more useful for drug prescription decision in patients with type 2 diabetes. We studied 85 patients with type 2 diabetes (35 women, 50 men; age 43.93±10.87 years, disease duration 21.91±6.07 years) receiving different treatment regimens (31 on oral therapy, 33 treated with premixed insulin, 21 on multiple insulin injections). Patients performed Non-Real Time Continuous Glucose Monitoring by using iProTM for seven days and HbA1c was measured at the end of this period. No difference in HbA1c level was found in three groups. HbA1c showed moderate negative correlation to percentage of time within the limits derived from CGM (r1= -0.654; r2= -0.674; r3= -0.521) with no dependence on therapeutic regimen. Moderate positive correlation was found between HbA1c and time spent above the limit and moderate negative correlation with time within the limit. CGM was more precise than HbA1c in defining patients with good control (p<0.05). HbA1c correlates badly with overall glucose excursion (r1=-0.096, r2=0.200, r3=0,377). No difference was found between studied groups in regard to CGM percentage of time spent within the limits, above and below the limits, as well as to AUC above upper limit. We conclude that CGM is more precise than HbA1c in diabetes control assessment and thus in treatment adjustment. Much more information is received from CGM ant the latter gives opportunity to find the most appropriate drug and to achieve optimal results. Disclosure T. Totomirova: None. M. Arnaudova: None.