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 people with microvascular disorders. type 1 diabetes.

Retrospectively analyzing CGM data from more than 160 adult patients, the study found that time in range, time in narrower range, time out of range, and average blood glucose levels were associated with an increased risk of: suggests that they are related. Development of diabetic retinopathy This emphasizes the importance of glycemic control and also draws 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, Therapeutics, and Real-World Perspectives. “Regardless of whether we use HbA1c or time in range, our results suggest that both indicators are important for long-term glycemic control in relation to individual glycemic control and microvascular complications. They provide very 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 the eye examination defining the onset of diabetic retinopathy or control, researchers used a logistic regression model to predict the onset of diabetic retinopathy. We planned to estimate the association between and CGM indicators.¹

The average age of the adult cohort with 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, the 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 the 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 et al. Reach distance 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/}}