Time in range, CGM metric for predicting diabetes outcome

A new study provides further evidence of the utility of time in range and other advanced continuous glucose monitoring (CGM) indicators in preventing negative microvascular outcomes in patients with type 1 diabetes.

In a retrospective analysis of CGM data from more than 160 adult patients, study results showed that time in range, time in narrow range, time outside range, and mean blood glucose levels were significantly lower in adults with type 1 diabetes. This suggests that it is associated with an increased risk of developing diabetic retinopathy. They emphasize the importance of glycemic control and also call attention to the usefulness of blood glucose metrics and time in range in disease management.

“The results were very similar,” Bilal Shah, MD, a professor of medicine at Indiana University, explained on the show. Diabetes Dialogue: Technology, Treatments, and Real-World Perspectives. “Whether using HbA1c or time in range, the results suggest that both indicators are highly predictive of long-term individual glycemic control in relation to microvascular complications. This means that they provide similar information. ”

If you have type 1 diabetes, your lifetime risk of developing diabetic retinopathy is about 90%. It is the most common eye disease in patients with type 1 diabetes, and identifying factors that put patients at risk for progression and measures to reduce the risk has been the focus of research efforts, including this study by Shah et al. .^1,2

In the study, researchers looked at 92 adults without diabetic retinopathy and 71 adults with diabetic retinopathy who were treated between June 2018 and March 2022. Utilizing CGM data collected retrospectively for up to 7 years from the date of eye examination to define onset of diabetic retinopathy or controls, researchers used a logistic regression model to determine the onset of diabetic retinopathy. We planned to estimate the association between and CGM indicators.¹

The average age of the adult cohort who developed diabetic retinopathy was 27 years, the average duration of diabetes was 15 years, and 52% were female. The mean age of the control group was 38 years, mean duration of diabetes was 20 years, and 48% were women.¹

After adjustment, the researchers’ analysis showed a 0.5% increase in HbA1c, a 10mg/dL increase in average blood glucose, a 5% decrease in time in the 70-180mg/dL target range, and 5% time in the strict target. A decrease was evident. A range of 70 to 140 mg/dL and a 5% increase in time above 180 mg/dL increased the probability of developing diabetic retinopathy by 24%, 22%, 18%, 28%, and 20%, respectively. was associated with an increase in The researchers noted that Spearman correlations between time in range, time in the narrower range, time outside the range, and average blood sugar levels were all 0.97 or higher.¹

This study, its results, and the utility of advanced CGM metrics in guiding treatment are the subject of this episode. diabetes dialogue, Diana Isaacs, Pharm.D., endocrine clinical pharmacist, director of diabetes technology education and training, and co-director of endocrine diseases in pregnancy at the Cleveland Clinic, and DNP, director of the diabetes technology program at University Hospitals Diabetes and Metabolism. Collaborate with Natalie Bellini. care center.

Disclosures related to Shah include Novo Nordisk, Dexcom Inc., Insulet Corporation, Tandem Diabetes Care, and others. Disclosures related to Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Bellini-related disclosures include Abbott Diabetes Care, MannKind, Prevention Bio, and more.

References:

1. _{^{Shah VN, Kanapka LG, Akturk HK Alternative flight time is associated with the development of diabetic retinopathy in adults with type 1 diabetes: a longitudinal study. diabetes technolcer. Published online on February 13, 2024. doi:10.1089/dia.2023.0486}}
2. _{^{Stewart JM, Caussin M, Schwartz DM. Diabetic retinopathy. [Updated 2021 Jan 3]. Authors: Feingold KR, Anawalt B, Blackman MR, et al., editors.end text [Internet]. South Dartmouth, Massachusetts: MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278967/}}