Discussion
insulin-treated, anemia, hypoglycemia, hypoglycemic, hemolysis
ANEMIA, HEMOGLOBINOPATHY, HYPOGLYCEMIA, REGRESSION, HEMOLYSIS, TYPE 2 DIABETES
Our study analyzed the correlation of MEANTo our knowledge, our study was the first to use a ridge regression model to establish a model using FCG and PCG together to predict HbA1c in patients with type 2 diabetes. This new HbA1c prediction model was appropriate for patients who were not suitable for HbA1c measurement after adjusting hypoglycemic treatment for less than 3 months, especially when patients only reached FCG or PCG target. Individualized predicted HbA1c with SMBG results was used to determine whether the hypoglycemic treatment should be adjusted to promote HbA1c to reach the goal quickly. When the patient’s actual HbA1c was inconsistent with the predicted HbA1c, the cause should be actively sought, such as frequent hypoglycemia, anemia, hemolysis, pregnancy, hemoglobinopathy, etc. In these patients, the new HbA1c prediction model might be applied to evaluate long-term glycemic control.Our study showed that FCG had a stronger predictive performance for HbA1c than FPG alone, which was similar to the results of a previous study (Compared with the new prediction model, simple linear model with FCG showed comparable ability to identify patients with HbA1c <7%, but the simple linear model with PCG showed worse ability. It indicated that FCG had a higher value than PCG in determining whether patients had achieved an HbA1c goal of <7%. This was consistent with previous reports that premeal blood glucose was more closely related to HbA1c than postmeal blood glucose (There was a discrepancy between the actual HbA1c and predicted HbA1c by the new HbA1c prediction model in this study. In patients who had only FCG within control target range, about 1/3 of patients with actual HbA1c <7.0% had predicted HbA1c ≥7%. Compared to patients with actual and predicted HbA1c <7.0%, we found that more patients had experience hypoglycemia in those with actual HbA1c <7.0% and predicted HbA1c ≥7%. The possible explanation was that these patients had a higher risk of hypoglycemia, which lead to the actual HbA1c reaching the goal. At this time, the actual HbA1c might be inaccurate, suggesting that clinicians should not reduce blood glucose excessively to further increase the risk of hypoglycemia in this case. For those who had only PCG within control target range, 1/4 of the patients with actual HbA1c <7% had predicted HbA1c ≥7%. Limited by the number of people with hypoglycemia occurrence, it was difficult to speculate whether these people had an increased risk of hypoglycemia.Studies have found that blood glucose testing number correlated with HbA1c attainment in insulin-treated patients (The strength of this study was that it was a multicenter study, and only required type 2 diabetes with insulin-treated and non-insulin-treated to have at least three FCG and three PCG measurements, indicating that this study had good extrapolation in type 2 diabetes. Several limitations exist in the current study. First, SMBG measurements were performed by the patient’s glucose-monitoring devices. Improper operation during blood glucose measurement, expiration of the test strip, and failure to calibrate might affect the accuracy and precision of the glucose readings. Second, the SMBG values were collected from four points including fasting and after three meals for several days over 3 months, some higher or lower values might be missed. But each point glucose value had at least 3 measurements for each patient with stable hypoglycemic treatment, which avoid a snapshot of glucose variability and reduce the impact of intra-individual differences. Third, validation of the new HbA1c prediction model was performed internally, and further validation of the model in external populations will be required in the future. Fourth, the efficacy and safety of this new HbA1c prediction model remained to be investigated, and we are conducting clinical trials to evaluate its efficacy and safety in patients with type 2 diabetes who have just been adjusted for hypoglycemic treatment.In conclusion, we have established the association between FCG, PCG and HbA1c and developed a new HbA1c prediction model based on both FCG and PCG. The new HbA1c prediction model provided an available and convenient way to convert real-time SMBG readings to HbA1c. Applying the new HbA1c prediction model might help to make the most of SMBG information and promote HbA1c to reach the goal quickly in patients with type 2 diabetes.