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Continuous glucose monitoring and microvascular complications in diabetes: Bridging glycemic metrics with clinical outcomes

Lilian Anagnostopoulou,A. Liarakos,I. Ntanasis-Stathopoulos,A. Briasoulis,Anastasios Tentolouris

Published 2025 in Diabetes, obesity and metabolism

ABSTRACT

Continuous glucose monitoring (CGM) has emerged as a complementary and more dynamic method for evaluating glycemic control in people with diabetes. Relevant studies examining the association between CGM parameters, including time in range (TIR), glycemic variability (GV), and time in tight range (TITR), and diabetic nephropathy, retinopathy, and neuropathy, were reviewed. Evidence consistently demonstrates that lower TIR and TITR, as well as higher GV, are associated with increased risk and severity of microvascular complications in both type 1 and type 2 diabetes. Studies employing corneal confocal microscopy and sudomotor function testing further support these associations for small‐fibre neuropathy. Although CGM‐guided therapy improves TIR and GV, data directly linking optimisation of these metrics to reduced complication rates remain limited. Most available studies are cross‐sectional or retrospective, with short CGM durations and heterogeneous methodologies. CGM‐derived indices provide valuable insights into glycemic quality beyond HbA1c and may serve as complementary tools for early risk stratification and individualised management of diabetic microvascular disease. However, prospective and interventional trials are required to confirm whether improving CGM metrics can translate into clinically meaningful reductions in microvascular morbidity. Broader access to CGM and standardisation of its key metrics will be essential to fully realise its potential in modern diabetes care.

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