title: The relationship between HbA1c values and the occurrence of hypoglycemia as assessed by continuous glucose monitoring in patients with type 1 diabetes.
abstract: BACKGROUND
  We aimed to examine the relationship between the occurrence of hypo-/hyperglycemia and HbA1c values, as assessed by continuous glucose monitoring (CGM) in patients with type 1 diabetes.
  
  
  METHODS
  The study subjects comprised 101 type 1 diabetic patients on basal-bolus insulin therapy, who were put on masked CGM immediately after admission. The subjects were divided into four groups equally by HbA1c values and the 24-h CGM data were compared among the groups.
  
  
  RESULTS
  Groups A to D comprised 24 patients with HbA1c ≤7.2 %, 26 patients with 7.2 % <HbA1c ≤8.2 %, 27 patients with 8.2 % <HbA1c ≤9.2 %, and 24 patients with HbA1c >9.2 %, respectively. The higher the HbA1c values, the significantly higher the 24-h mean glucose levels [median (25-75 percentiles)], with the HbA1c in groups A to D being 133 (114-155), 158 (132-188), 182 (152-206), and 186 (143-215) mg/dL, respectively (P < 0.001). Conversely, the higher the HbA1c values, the significantly shorter the time in hypoglycemia (<70 mg/dL), with the time in groups A to D being 170 (58-341), 78 (0-210), 45 (0-105), and 20 (0-105) min, respectively (P = 0.014); and the higher the HbA1c values, the significantly shorter the time in nocturnal hypoglycemia, with the time in groups A to D being 120 (5-269), 25 (0-120), 0 (0-60), and 0 (0-89) min, respectively (P = 0.019). No significant difference was seen between groups A to D in the standard deviations (SDs) of 24-h glucose values at 53 (40-65), 54 (45-70), 64 (55-76), and 58 (48-80), respectively.
  
  
  CONCLUSIONS
  In type 1 diabetic patients, lower HbA1c was not associated with lower SD of 24-h glucose values, but may result in increased hypoglycemia. Trial Registration Current controlled trials UMIN000019190.
authors.affiliation: Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-15-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461 Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tsujino
authors.affiliation: Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-15-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461 Japan ; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA.
authors.forename: Rimei
authors.initials: R
authors.lastname: Nishimura
authors.affiliation: Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-15-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461 Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Onda
authors.affiliation: Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-15-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461 Japan.
authors.forename: Chiaki
authors.initials: C
authors.lastname: Seo
authors.affiliation: Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-15-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461 Japan.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Ando
authors.affiliation: Morimoto Hospital, Tokyo, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Morimoto
authors.affiliation: Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-15-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461 Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Utsunomiya
keywords: CGM; Continuous glucose monitoring; HbA1c; Hypoglycemia; Type 1 diabetes