BACKGROUND While glycated hemoglobin (HbA1c) remains the clinical cornerstone for monitoring type 2 diabetes (T2D), the prognostic value of the cumulative glycemic burden and its dynamic trajectories

The gap

Consensus across the literature

Supporting evidence — 4 representative gaps

• Beyond HbA1c: Alternative Glycemic Biomarkers in Hemoglobinopathies, Malignancy, and Special Clinical Populations - A Review (2026) · doi

  (2) IJDDT, Volume 16 Issue 7s, 2026 304 Beyond HbA1c: Alternative Glycemic Biomarkers in Hemoglobinopathies, Malignancy, and Special Clinical Populations - A Review and studies; mechanistic incorporating (3) elucidating perioperative management; emerging evidence from continuous glucose monitoring validation the complex bidirectional relationships between hyperglycemia and cancer, pathways, epidemiological evidence, and implications for cancer screening (4) synthesizing recent advances in assay technology, standardization initiatives, and quality assurance programs; and (5) providing evidence-based clinical decision algorithms and practical implementation guidance for biomarker selection tailored to specific clinical scenarios. Through this integrative approach, we aim to equip clinicians with the knowledge and tools necessary to deliver precision glycemic assessment that transcends traditional HbA1c-centric paradigms and optimizes outcomes for patients with complex comorbidities. METHODOLOGY

  Keywords: clinical evidence glycemic complex cancer ijddt volume issue beyond alternative biomarkers hemoglobinopathies malignancy special populations
• Beyond HbA1c: Alternative Glycemic Biomarkers in Hemoglobinopathies, Malignancy, and Special Clinical Populations - A Review (2026) · doi

  intensification. However, by HbA1c, physiology, retinopathy significant pregnancy detected predicts guiding ability spot to in IJDDT, Volume 16 Issue 7s, 2026 320 Beyond HbA1c: Alternative Glycemic Biomarkers in Hemoglobinopathies, Malignancy, and Special Clinical Populations - A Review enabling important standardization including renal dysfunction invalidation (eGFR <30), dietary confounding, SGLT2 inhibitor interference, and floor effect in poor control restrict utility to specific contexts. Limitations of Current Evidence and Practice

  Keywords: intensification physiology retinopathy significant pregnancy detected predicts guiding ability spot ijddt volume issue beyond alternative
• Dynamic glycemic exposure and trajectory profiling for incident diabetic kidney disease: A longitudinal cohort study (2026) · doi

  BACKGROUND While glycated hemoglobin (HbA1c) remains the clinical cornerstone for monitoring type 2 diabetes (T2D), the prognostic value of the cumulative glycemic burden and its dynamic trajectories for predicting incident diabetic kidney disease (DKD) remains insufficiently characterized.

  Keywords: remains background glycated hemoglobin clinical cornerstone monitoring type diabetes prognostic value cumulative glycemic burden dynamic
• Continuous glucose monitoring in diabetes management – evidence, applications, and future perspectives: A comprehensive review of recent developments (2026) · doi

  trials, differences lower adherence and Major limitations identified in studies of CGM in type 1 diabetes include substantial heterogeneity among in study design and population characteristics, and potential bias from industry sponsorship. The exclusion of participants with the predominant use of HbA1c as a primary endpoint may reduce generalizability and fail to capture the full range of glycemic variability. Furthermore, the growing integration of CGM into automated insulin delivery systems reduces the re-levance of findings derived from studies assessing stand-alone monitoring [13].

  Keywords: trials differences lower adherence major limitations identified type diabetes include substantial heterogeneity among design population