Glycemic Key Metrics and the Risk of Diabetes-Associated Complications

Prevention of diabetes-associated complications is closely linked to preventing and controlling hyperglycemia. Glycated hemoglobin (HbA1c), a glucose metric and a risk factor for chronic complications, is not reliable under certain clinical conditions, does not capture glyemic variability and glucose dynamics. There is evidence that glycemic variability is an independent predictor variable of hypoglycemia and a potential risk marker for vascular diabetes complications. Despite advanced glucose monitoring methods, monitoring of glucose with blood glucose meters remains indispensible as an adjunct to HbA1c measurements, because it gives direct feedback on short-term changes in glucose levels. Optimized diabetes treatment and prevention or delay of diabetes complications needs both key glucose control metrics on a daily basis, involving fasting, preprandial, and postprandial glucose levels as well as advanced, user-friendly monitoring methods. The broad application of systems for continuous glucose monitoring in clinical settings is partly hampered by lacking measures generally accepted for analysis of glucose profiles and as standards for reporting of glucose data. We performed a literature search, using PubMed and Scopus and included relevant literature published online up to March 1, 2016. In this review, we discuss the importance of several glucose measures for primary and secondary prevention of diabetes complications and possibilities for evaluation of monitored glucose data with special consideration of glycemic variability, glucose dynamics, and the utility of continuous glucose monitoring