ĐƯỜNG HUYẾT MAO MẠCH VÀ HBA1C TRONG QUẢN LÝ ĐÁI THÁO ĐƯỜNG TÝP 2: MỐI LIÊN HỆ VÀ ỨNG DỤNG LÂM SÀNG
Nội dung chính của bài viết
Tóm tắt
Kiểm soát đường huyết hiệu quả là mục tiêu cốt lõi trong quản lý bệnh đái tháo đường (ĐTĐ) týp 2 nhằm ngăn chặn sự tiến triển bệnh và giảm nguy cơ biến chứng lâu dài. Mục tiêu của bài tổng quan tập trung phân tích mối liên hệ giữa đường huyết mao mạch và hemoglobin A1c (HbA1c), đồng thời tối ưu hóa việc kiểm soát đường huyết ở người bệnh ĐTĐ týp 2. Tổng hợp kết quả từ các nghiên cứu gần đây cho thấy đường huyết mao mạch và HbA1c có mối liên quan chặt chẽ với nhau, tuy nhiên vẫn có sự ảnh hưởng do biến thiên đường huyết và các yếu tố cá thể. Do đó, việc sử dụng HbA1c đơn lẻ không phản ánh đầy đủ tình trạng kiểm soát đường huyết thực tế. Việc kết hợp HbA1c và đường huyết mao mạch đóng góp vào việc tối ưu hóa kiểm soát và điều trị bệnh. Xu hướng sử dụng tích hợp công nghệ hiện đại trong quản lý bệnh ĐTĐ týp 2 đang được quan tâm và áp dụng nhờ khả năng phân tích nhiều chỉ số và công nghệ theo dõi đường huyết, từ đó đưa ra các giải pháp điều trị và cải thiện tình trạng cho người bệnh.
Từ khóa
Glucose máu mao mạch, Hemoglobin A1c, ứng dụng lâm sàng.
Chi tiết bài viết
Tài liệu tham khảo
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12. Monnier L, Colette C. Targeting prandial hyperglycemia: how important is it and how best to do this? Curr Diab Rep. 2008;8(5):368–74. doi:10.1007/s11892-008-0064-3.
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14. Beregszàszi M, Tubiana-Rufi N, Benali K, Noël M, Bloch J, et al. Nocturnal hypoglycemia in children and adolescents with insulin-dependent diabetes mellitus: prevalence and risk factors. J Pediatr. 1997;131(1):27–33. doi:10.1016/S0022-3476(97)70120-8. doi:10.1016/S0140-6736(10)60484-9.
15. Bell PM, Walshe K. Benefits of self monitoring of blood glucose. Br Med J (Clin Res Ed). 1983;286(6373):1230. doi:10.1136/bmj.286.6373.1230.
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17. Muhali SS, Muhali FS, Mfinanga SG, Sadiq AM, Marandu AA, et al. Impact of self‐monitoring blood glucose on Glycaemic control among insulin‐treated patients with diabetes mellitus in northeastern Tanzania: a randomised controlled trial. J Diabetes Res. 2024;2024(1):6789672. doi:10.1155/2024/6789672.
18. Kato N, Cui J, Kato M. Structured self‐monitoring of blood glucose reduces glycated hemoglobin in insulin‐treated diabetes. J Diabetes Investig. 2013;4(5):450–3. doi:10.1111/jdi.12096.
19. Saboo B, Kalra P, Majumdar S, Phatak S, Deka N, et al. Current Practices and Perspectives of Clinicians on Glucose Monitoring in Indian Patients with Type 2 Diabetes Mellitus. International Journal of Diabetes and Technology. 2025;4(4):152–8.
20. Polonsky WH, Fisher L, Schikman CH, Hinnen DA, Parkin CG, Jelsovsky Z, et al. Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes. Diabetes Care. 2011;34(2):262-267. doi:10.2337/dc10-1732.
21. Nitin S. HbA1c and factors other than diabetes mellitus affecting it. Singapore Med J. 2010;51(8):616–22.
22. American Diabetes Association. Standards of Medical Care in Diabetes—2021. Diabetes Care. 2021;44(Suppl 1):S1-S232. doi:10.2337/dc21-SINT.
23. Organization WH. Use of glycated haemoglobin (HbA1c) in diagnosis of diabetes mellitus: abbreviated report of a WHO consultation. World Health Organization; 2011.
24. American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care. 2017;40(Suppl 1):S11-S24. doi:10.2337/dc17-S005.
25. Wang S, Song S, Gao J, Duo Y, Gao Y, et al. Glycated haemoglobin variability and risk of renal function decline in type 2 diabetes mellitus: an updated systematic review and meta-analysis. Diabetes Obes Metab. 2024;26(11):5167-5182. doi:10.1111/dom.15840.
26. Mohammedi K, Woodward M, Marre M, Colagiuri S, Cooper M, et al. Comparative effects of microvascular and macrovascular disease on the risk of major outcomes in patients with type 2 diabetes. Cardiovasc Diabetol. 2017;16(1):95. doi:10.1186/s12933-017-0574-y.
27. American Diabetes Association. Standards of Medical Care in Diabetes—2022. Diabetes Care. 2022;45(Suppl 1):S1-S264. doi:10.2337/dc22-SINT.
28. Liddy AM, Grundy S, Sreenan S, Tormey W. Impact of haemoglobin variants on the use of haemoglobin A1c for the diagnosis and monitoring of diabetes: a contextualised review. Ir J Med Sci. 2023;192(1):169-176. doi:10.1007/s11845-022-03074-0.
29. Yuan Y, Zhou X, Jia W, Zhou J, Zhang F, et al. The association between self-monitoring of blood glucose and HbA1c in type 2 diabetes. Front Endocrinol (Lausanne). 2023;14:1056828. doi:10.3389/fendo.2023.1056828.
30. Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, et al. Translating the A1C assay into estimated average glucose values. Diabetes Care. 2008;31(8):1473-1478. doi:10.2337/dc08-0545.
31. Liu Z, Lin B, Chen D, Yang Y, Jiang W, et al. The related factors affecting the relationship between HbA1c and glucose management indicator in adult T2D patients with good glycemic control. Endocrine. 2025;87(2):609-618. doi:10.1007/s12020-024-04079-z..
32. Swaby R, Randell T. Strategies for optimising blood glucose control in diabetes mellitus. Paediatr Child Health. 2021;31(4):146-152. doi:10.1016/j.paed.2020.12.003.
33. American Diabetes Association Professional Practice Committee. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S111-S125. doi:10.2337/dc24-S006.
34. Munshi MN, Segal AR, Slyne C, Samur AA, Brooks KM, et al. Shortfalls of the use of HbA1c-derived eAG in older adults with diabetes. Diabetes Res Clin Pract. 2015;110(1):60-65. doi:10.1016/j.diabres.2015.08.007.
35. Rajan SS, Misquith A, Rangareddy H. Calculated glycosylated hemoglobin (HbA1c) compared with estimated HbA1c by nephelometry and its correlation to estimated average blood glucose (eAG). Galore International Journal of Health Sciences and Research (www gijhsr com). 2020;5(4).
36. Tozzo V, Genco M, Omololu SO, Mow C, Patel HR, et al. Estimating glycemia from HbA1c and CGM: analysis of accuracy and sources of discrepancy. Diabetes Care. 2024;47(3):460-466. doi:10.2337/dc23-1509.
37. Tozzo V, Nathan DM, Krause-Steinrauf H, Lachin JM, Larkin ME, et al. Differences Between Glycemia Estimates from Hemoglobin A1c and Continuous Glucose Monitoring and Their Association with Complete Blood Counts. Diabetes Technol Ther. 2025;15209156251395036.
38. Tashkandi M. Revis-iting HbA1c in type 2 diabetes: Strengths, pitfalls, and emerg-ing alternatives. Glob Jour Bas Sci. 2025;1(10):1–5.
39. Eliasson B, Allansson Kjölhede E, Salö S, Fabrin Nielsen N, Eeg-Olofsson K. Associations between HbA1c and glucose time in range using continuous glucose monitoring in type 1 diabetes: cross-sectional population-based study. Diabetes Ther. 2024;15(6):1301-1312. doi:10.1007/s13300-024-01596-7.
40. Alfadli SF, Alotaibi YS, Aqdi MJ, Almozan LA, Alzubaidi ZB, et al. Effectiveness of continuous glucose monitoring systems on glycemic control in adults with type 1 diabetes: a systematic review and meta-analysis. Metabol Open. 2025;25:100382. doi:10.1016/j.metop.2025.100382.
41. Cao W, Zou J, Gao M, Huang J, Li Y, et al. A comparative study of the relationship between time in range assessed by self-monitoring of blood glucose and continuous glucose monitoring with microalbuminuria outcome, HOMA-IR and HOMA-β test. J Diabetes Complications. 2024;38(10):108831. doi:10.1016/j.jdiacomp.2024.108831.
42. Stratton IM, Adler AI, Neil HAW, Matthews DR, Manley SE, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321(7258):405-412. doi:10.1136/bmj.321.7258.405.
43. Farmer AJ, Perera R, Ward A, Heneghan C, Oke J, Barnett AH, et al. Meta-analysis of individual patient data in randomised trials of self monitoring of blood glucose in people with non-insulin treated type 2 diabetes. BMJ. 2012;344:e486. doi:10.1136/bmj.e486.
2. Makris K, Spanou L. Is there a relationship between mean blood glucose and glycated hemoglobin? J Diabetes Sci Technol. 2011;5(6):1572–83.
3. Battelino T, Danne T, Bergenstal RM, Amiel SA, Beck R, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care. 2019;42(8):1593–603. doi:10.2337/dci19-0028.
4. Mathew TK, Tadi P. Blood glucose monitoring. StatPearls. Treasure Island, FL: StatPearls Publishing. 2020.
5. ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, et al. 7. Diabetes Technology: Standards of Care in Diabetes—2024. Diabetes Care. 2024;47. doi:10.2337/dc24-S007.
6. Rama Chandran S, Tay WL, Lye WK, Lim LL, Ratnasingam J, et al. Beyond HbA1c: comparing glycemic variability and glycemic indices in predicting hypoglycemia in type 1 and type 2 diabetes. Diabetes Technol Ther. 2018;20(5):353–62. doi:10.1089/dia.2017.0388.
7. Chircop J, Sheffield D, Kotera Y. Systematic review of self-monitoring of blood glucose in patients with type 2 diabetes. Nurs Res. 2021;70(6):487-497. doi:10.1097/NNR.0000000000000542.
8. Nielsen H, Nielsen GL. Preprandial blood glucose values: influence on glycemic response studies. Am J Clin Nutr. 1989;49(6):1243–6. doi:10.1093/ajcn/49.6.1243.
9. American Diabetes Association Professional Practice Committee. 6. Glycemic goals and hypoglycemia: Standards of Care in Diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S111-S125. doi:10.2337/dc24-S006.
10. Akanji AO, Nzegwu AA, Agbedana EO. Some determinants of postprandial lipaemia in Nigerian diabetic and non-diabetic subjects. British journal of nutrition. 1992;68(1):153–62. doi:10.1079/BJN19920075.
11. Lin HJ, Lee BC, Ho YL, Lin YH, Chen CY, et al. Postprandial glucose improves the risk prediction of cardiovascular death beyond the metabolic syndrome in the nondiabetic population. Diabetes Care. 2009;32(9):1721–6. doi:10.2337/dc08-2338.
12. Monnier L, Colette C. Targeting prandial hyperglycemia: how important is it and how best to do this? Curr Diab Rep. 2008;8(5):368–74. doi:10.1007/s11892-008-0064-3.
13. Allen K V, Frier BM. Nocturnal hypoglycemia: clinical manifestations and therapeutic strategies toward prevention. Endocrine practice. 2003;9(6):530–43. doi:10.4158/EP.9.6.530.
14. Beregszàszi M, Tubiana-Rufi N, Benali K, Noël M, Bloch J, et al. Nocturnal hypoglycemia in children and adolescents with insulin-dependent diabetes mellitus: prevalence and risk factors. J Pediatr. 1997;131(1):27–33. doi:10.1016/S0022-3476(97)70120-8. doi:10.1016/S0140-6736(10)60484-9.
15. Bell PM, Walshe K. Benefits of self monitoring of blood glucose. Br Med J (Clin Res Ed). 1983;286(6373):1230. doi:10.1136/bmj.286.6373.1230.
16. Collaboration ERF. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. The lancet. 2010;375(9733):2215–22. doi:10.1016/S0140-6736(10)60484-9.
17. Muhali SS, Muhali FS, Mfinanga SG, Sadiq AM, Marandu AA, et al. Impact of self‐monitoring blood glucose on Glycaemic control among insulin‐treated patients with diabetes mellitus in northeastern Tanzania: a randomised controlled trial. J Diabetes Res. 2024;2024(1):6789672. doi:10.1155/2024/6789672.
18. Kato N, Cui J, Kato M. Structured self‐monitoring of blood glucose reduces glycated hemoglobin in insulin‐treated diabetes. J Diabetes Investig. 2013;4(5):450–3. doi:10.1111/jdi.12096.
19. Saboo B, Kalra P, Majumdar S, Phatak S, Deka N, et al. Current Practices and Perspectives of Clinicians on Glucose Monitoring in Indian Patients with Type 2 Diabetes Mellitus. International Journal of Diabetes and Technology. 2025;4(4):152–8.
20. Polonsky WH, Fisher L, Schikman CH, Hinnen DA, Parkin CG, Jelsovsky Z, et al. Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes. Diabetes Care. 2011;34(2):262-267. doi:10.2337/dc10-1732.
21. Nitin S. HbA1c and factors other than diabetes mellitus affecting it. Singapore Med J. 2010;51(8):616–22.
22. American Diabetes Association. Standards of Medical Care in Diabetes—2021. Diabetes Care. 2021;44(Suppl 1):S1-S232. doi:10.2337/dc21-SINT.
23. Organization WH. Use of glycated haemoglobin (HbA1c) in diagnosis of diabetes mellitus: abbreviated report of a WHO consultation. World Health Organization; 2011.
24. American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care. 2017;40(Suppl 1):S11-S24. doi:10.2337/dc17-S005.
25. Wang S, Song S, Gao J, Duo Y, Gao Y, et al. Glycated haemoglobin variability and risk of renal function decline in type 2 diabetes mellitus: an updated systematic review and meta-analysis. Diabetes Obes Metab. 2024;26(11):5167-5182. doi:10.1111/dom.15840.
26. Mohammedi K, Woodward M, Marre M, Colagiuri S, Cooper M, et al. Comparative effects of microvascular and macrovascular disease on the risk of major outcomes in patients with type 2 diabetes. Cardiovasc Diabetol. 2017;16(1):95. doi:10.1186/s12933-017-0574-y.
27. American Diabetes Association. Standards of Medical Care in Diabetes—2022. Diabetes Care. 2022;45(Suppl 1):S1-S264. doi:10.2337/dc22-SINT.
28. Liddy AM, Grundy S, Sreenan S, Tormey W. Impact of haemoglobin variants on the use of haemoglobin A1c for the diagnosis and monitoring of diabetes: a contextualised review. Ir J Med Sci. 2023;192(1):169-176. doi:10.1007/s11845-022-03074-0.
29. Yuan Y, Zhou X, Jia W, Zhou J, Zhang F, et al. The association between self-monitoring of blood glucose and HbA1c in type 2 diabetes. Front Endocrinol (Lausanne). 2023;14:1056828. doi:10.3389/fendo.2023.1056828.
30. Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, et al. Translating the A1C assay into estimated average glucose values. Diabetes Care. 2008;31(8):1473-1478. doi:10.2337/dc08-0545.
31. Liu Z, Lin B, Chen D, Yang Y, Jiang W, et al. The related factors affecting the relationship between HbA1c and glucose management indicator in adult T2D patients with good glycemic control. Endocrine. 2025;87(2):609-618. doi:10.1007/s12020-024-04079-z..
32. Swaby R, Randell T. Strategies for optimising blood glucose control in diabetes mellitus. Paediatr Child Health. 2021;31(4):146-152. doi:10.1016/j.paed.2020.12.003.
33. American Diabetes Association Professional Practice Committee. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S111-S125. doi:10.2337/dc24-S006.
34. Munshi MN, Segal AR, Slyne C, Samur AA, Brooks KM, et al. Shortfalls of the use of HbA1c-derived eAG in older adults with diabetes. Diabetes Res Clin Pract. 2015;110(1):60-65. doi:10.1016/j.diabres.2015.08.007.
35. Rajan SS, Misquith A, Rangareddy H. Calculated glycosylated hemoglobin (HbA1c) compared with estimated HbA1c by nephelometry and its correlation to estimated average blood glucose (eAG). Galore International Journal of Health Sciences and Research (www gijhsr com). 2020;5(4).
36. Tozzo V, Genco M, Omololu SO, Mow C, Patel HR, et al. Estimating glycemia from HbA1c and CGM: analysis of accuracy and sources of discrepancy. Diabetes Care. 2024;47(3):460-466. doi:10.2337/dc23-1509.
37. Tozzo V, Nathan DM, Krause-Steinrauf H, Lachin JM, Larkin ME, et al. Differences Between Glycemia Estimates from Hemoglobin A1c and Continuous Glucose Monitoring and Their Association with Complete Blood Counts. Diabetes Technol Ther. 2025;15209156251395036.
38. Tashkandi M. Revis-iting HbA1c in type 2 diabetes: Strengths, pitfalls, and emerg-ing alternatives. Glob Jour Bas Sci. 2025;1(10):1–5.
39. Eliasson B, Allansson Kjölhede E, Salö S, Fabrin Nielsen N, Eeg-Olofsson K. Associations between HbA1c and glucose time in range using continuous glucose monitoring in type 1 diabetes: cross-sectional population-based study. Diabetes Ther. 2024;15(6):1301-1312. doi:10.1007/s13300-024-01596-7.
40. Alfadli SF, Alotaibi YS, Aqdi MJ, Almozan LA, Alzubaidi ZB, et al. Effectiveness of continuous glucose monitoring systems on glycemic control in adults with type 1 diabetes: a systematic review and meta-analysis. Metabol Open. 2025;25:100382. doi:10.1016/j.metop.2025.100382.
41. Cao W, Zou J, Gao M, Huang J, Li Y, et al. A comparative study of the relationship between time in range assessed by self-monitoring of blood glucose and continuous glucose monitoring with microalbuminuria outcome, HOMA-IR and HOMA-β test. J Diabetes Complications. 2024;38(10):108831. doi:10.1016/j.jdiacomp.2024.108831.
42. Stratton IM, Adler AI, Neil HAW, Matthews DR, Manley SE, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321(7258):405-412. doi:10.1136/bmj.321.7258.405.
43. Farmer AJ, Perera R, Ward A, Heneghan C, Oke J, Barnett AH, et al. Meta-analysis of individual patient data in randomised trials of self monitoring of blood glucose in people with non-insulin treated type 2 diabetes. BMJ. 2012;344:e486. doi:10.1136/bmj.e486.