10
NEWS
CGM for nondiabetics
A new study has found that standard metrics
generated by continuous glucose monitors (CGM),
such as average glucose, time-in-range (TIR), and the
glycaemic management indicator (GMI), may not align
with HbA1c in people who don't have diabetes.
The use of CGM has been growing among people
without diabetes, including those with prediabetes,
particularly with the availability of the over-thecounter
(OTC) devices. However, while studies have
looked at the correlation between CGM metrics
and HbA1c in patients with both Type 1 and Type
2 diabetes, fewer data exist on prediabetes or
normoglycemia.
Jorge A. Rodriguez, MD, of the Division of General
Internal Medicine and Primary Care, Brigham and
Women's Hospital, Boston and colleagues used data
from 972 individuals, including 43.3% with T2D,
32.8% with prediabetes, and 23.9% without diabetes
(normoglycemia). All had HbA1c measurements taken
before wearing the Dexcom G6 for up to 10 days.
Overall, the association between CGM metrics
and HbA1c was significantly stronger in the group
with Type 2 diabetes, compared with either the
prediabetes or normoglycemia group. Time-based
CGM metrics were also closely associated with HbA1c
in the Type group, including Time in Range and Time
in Tight Range.
In the group with prediabetes, the associations
between CGM metrics and HbA1c maintained
significance but much less strongly than for Type 2,
and among those without diabetes, the CGM metrics
showed minimal or nonsignificant associations with
HbA1c. "For people without diabetes, there's still
work to be done around what the specific glucose
thresholds should be and what clinicians should do
about it," said Rodriguez, "We're still figuring that out."
Finerenone, T1D
and CKD
The nonsteroidal antagonist drug finerenone has been
found to lead to significant reductions in albuminuria
in patients with Type 1 diabetes and chronic kidney
disease (CKD) compared to placebo.
Despite improvements in care over the years for
Type 1 diabetes, as many as 30% of all patients - and
up to 50% of patients aged 60 years or older - develop
CKD, also increasing the risk for cardiovascular disease.
This is the first work in T1D in over three decades
that has shown "a beneficial risk profile for patients that
will likely translate into long-term kidney protection
and possibly also cardiovascular disease prevention,"
said first author Hiddo J. Heerspink, MD, from the
University Medical Center Groningen, the Netherlands,
who presented the late-breaking findings.
Medications such as GLP-1 receptor agonists and
SGLT2 inhibitors indicated for Type 2 diabetes are not
currently indicated for Type 1, although they are being
increasingly prescribed. Finerenone addresses the
overactivation of the mineralocorticoid receptor, which
is a key factor in the progression of CKD.
To investigate the possible benefits of Finerenone,
Heerspink and colleagues enrolled 242 Type 1 patients
with CKD. They were randomized 1:1 to treatment
either with Finerenone or placebo. At three months,
significant differences between the groups were
already being observed, with a reduction in UACR from
baseline of 30% with Finerenone vs 10% with placebo.
At 6 months, the finerenone group had a reduction of
37% vs 13% in the placebo group.
"This effect is robust and clinically meaningful
because we know from clinical trials that a 25%
reduction in albuminuria is associated with a very high
likelihood of a long-term reduced risk of dialysis and
kidney transplantation," Heerspink said.
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