Beyond
HbA1c
: A
CGM
‐centred three‐pillar framework for glycaemic variability in pre‐diabetes and type 2 diabetes
Taoming Qian, Donghao Guo, Meijun Zhang, Yuhan Liu, Juan Jin Abstract
Background
Traditional management of type 2 diabetes mellitus (T2DM) and pre‐diabetes centres on HbA1c reduction, yet this single metric fails to capture glycaemic variability (GV)—an independent driver of β‐cell dysfunction, endothelial damage, oxidative stress, inflammation and cardiovascular risk, even in the pre‐diabetes stage. Unlike existing reviews that focus predominantly on T2DM or HbA1c‐centric approaches, this perspective articulates a unified three‐pillar closed‐loop framework that integrates continuous glucose monitoring (CGM) across the entire pre‐diabetes‐to‐remission continuum.
Perspective
We synthesize evidence from prospective cohorts, mechanistic studies, randomized controlled trials and real‐world data to demonstrate that GV is a modifiable therapeutic target. CGM uniquely reveals dynamic glucose patterns invisible to HbA1c, enabling precise, real‐time interventions that improve time in range (TIR), reduce GV and hypoglycaemia and support the achievement of clinical remission (HbA1c <48 mmol/mol (<6.5%) without glucose‐lowering medication for ≥3 months) in subsets of patients.
Conclusions
CGM‐centred management of glycaemic stability offers a clinically actionable paradigm shift from static, average‐glucose control to dynamic, precision‐guided care. The proposed three‐pillar framework—tiered personalized targets, data‐driven intelligent decision support and empowered patient–clinician collaboration—provides a structured roadmap grounded in current evidence. Long‐term outcomes in pre‐diabetes, cost‐effectiveness and global accessibility remain important areas for future investigation.