Δημοσιεύτηκαν οι νέες παγκόσμιες οδηγίες 2025 για τη διαχείριση του Σακχαρώδη Διαβήτη τύπου 2 από τη Διεθνή Ομοσπονδία για το Διαβήτη (International Diabetes Federation – IDF).
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GLYCAEMIC TARGETS – Key Points
o Glycaemic control reduces the risk of both micro- and macrovascular complications in
type 2 diabetes mellitus (T2DM).
o Assessing and monitoring glycaemia is an essential component of guiding treatment
decisions to achieve and maintain target glycaemic control.
o Setting glycaemic targets is based on established associations with adverse outcomes.
o HbA1c is the established gold standard for assessing glycaemic control in T2DM.
o The general HbA1c target of <7.0% (<53 mmol/mol) should be personalised, balancing
reducing complications, minimising hypoglycaemia and an individual’s characteristics.
o HbA1c measurement may be affected by a variety of factors – in these situations,
fructosamine and glycated albumin are alternatives for monitoring glycaemic control.
o Improving HbA1c improves diabetes outcomes in the short- and longer-term.
o HbA1c variability may be important but has not been definitively confirmed as an
independent risk factor for diabetes complications.
o The contribution of fasting plasma glucose (FPG) and postprandial glucose (PPG) to
overall glycaemia varies according to HbA1c levels, being greater for PPG at lower HbA1c
levels and greater for FPG at higher HbA1c levels.
o In select individuals with T2DM, HbA1c measurement may be complemented with selfmonitoring of blood glucose (SMBG) or continuous glucose monitoring (CGM).
o SMBG and CGM may provide additional useful clinical information on glycaemic
metrics relevant to diabetes management, including periods of hyperglycaemia and
hypoglycaemia.
o SMBG is recommended in insulin-treated T2DM but may be useful in other situations.
o SMBG use (intensity and frequency) should be structured and individualised.
o The proposed SMBG targets are adapted to align with CGM metrics.
o CGM is currently used mainly in people with type 1 diabetes mellitus (T1DM) but use is
increasing in insulin-treated T2DM in high-resource health settings. Data supporting its
use in non-insulin treated people with T2DM are limited.
o Key CGM metrics include glycaemic variability and time in defined glucose ranges.
o Target CGM metrics are based on international consensus.
o Most of the global diabetes population lives in low-income and middle-income countries
(LMICs) where access and affordability to HbA1c testing, SMBG, and CGM are limited.
GLYCAEMIC TARGETS – CGM metrics targets
Key metrics for assessing glycaemic status using continuous glucose monitoring (CGM)
in non-pregnant adults with diabetes.
| Metric | Interpretation | Goal |
|---|---|---|
| Number of days of CGM | 14 days | |
| Percentage of time CGM device is active | 70% data | |
| Coefficient of variation | Percentage coefficient of variation Intraday (i.e., within 24 h) and Interday (i.e., over multiple days) | ≤36% |
| Time in range 70–180 mg/dL (3.9–10.0 mmol/L) | Percentage readings and time in range | >70% (most adults) >50% (older adults) |
| Time below range <70 mg/dL (<3.9 mmol/L) including readings <54 mg/dL (<3.0 mmol/L) | Percentage readings and time below range | <4% (most adults) <1% (older adults) |
| Time below range <54 mg/dL (<3.0 mmol/L) | Percentage readings and time below range | <1% |
| Time above range >180 mg/dL (>10.0 mmol/L) including readings >250 mg/dL (> 13.9 mmol/L) | Percentage readings and time above range | <25% (most adults) <50% (older adults) |
| Time above range >250 mg/dL (> 13.9 mmol/L) | Percentage readings and time above range | <5% (most adults) <10% (older adults) |